the republic of uganda - oag · nms prices vs joint medical stores (jms), and local market prices...
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T H E R E P U B L I C O F U G A N D A
DECEMBER, 2016
A REPORT BY THE AUDITOR GENERAL
MANAGEMENT OF PROCUREMENTAND DISTRIBUTION OF ESSENTIAL
MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES
(A Study on Drug Pricing and Deliveries)
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MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
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31st December 2016
The Rt. Hon. Speaker of Parliament
Parliament of Uganda
Kampala
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIES BY NATIONAL MEDICAL STORES
(A STUDY ON DRUG PRICING AND DELIVERIES)
In accordance with Article 163 (3) of the Constitution, I hereby submit my report on the audit undertaken on management of procurement and distribution of essential medicines and health supplies by National Medical Stores
My office intends to carry out a follow – up at an appropriate time regarding actions taken in relation to the recommendations in this report.
I would like to thank my staff who undertook this audit and the staff of National Medical Stores and health centers for the assistance offered during the period of the audit.
John F. S. Muwanga
AUDITOR GENERAL
AUDITOR GENERALAUDITOR GENERAL’S MESSAGE
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TABLE OF CONTENTS
LIST OF TABLES .................................................................................................................... iii
LIST OF FIGURES .................................................................................................................. iv
LIST OF ABBREVIATIONS .......................................................................................................v
CHAPTER ONEINTRODUCTION
1.1 Background .............................................................................................................. 2
1.2 Motivation ................................................................................................................. 2
1.3 Description of the audit area ................................................................................... 3
1.4 Audit objective .......................................................................................................... 5
1.5 Audit scope ............................................................................................................... 5
CHAPTER TWOAUDIT METHODOLOGY
2.1 Sampling .................................................................................................................. 7
2.2 Data collection methods .......................................................................................... 8
CHAPTER THREESYSTEMS AND PROCESS DESCRIPTION
1.1 Roles and responsibilities of key players ............................................................... 10
1.2 Process description ................................................................................................ 11
CHAPTER FOURFINDINGS, CONCLUSIONS AND RECOMMENDATIONS
4.1 Drug Pricing .................................................................................................................... 14
4.2 Planning and Delivery of EMHS ..................................................................................... 24
4.3 Timeliness of EMHS Deliveries ...................................................................................... 30
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TABLE OF CONTENTS
APPENDICESAppendix I: Documents Reviewed ........................................................................................ 34
Appendix II: List of people interviewed ................................................................................ 35
Appendix III: Organizational Structure ................................................................................ 36
Appendix IV: Set Order and Delivery Timelines ................................................................... 37
Appendix V: Contract prices and supplier prices for various drugs over the years .......... 38
Appendix VI: Comparison between survey prices and published prices ............................ 39
Appendix VII: Showing additional mark-up charges and extra cost incurred by health
facilities between planning/ordering and issue. ................................................................. 40
Appendix VIII: List of health facilities that planned, ordered but did not receive............... 42
Appendix IX: Showing Unplanned, Not Ordered but Issued ................................................ 44
Appendix X: Showing health facilities that were issued drugs that they had neither
planned nor ordered for ................................................................................... 46
Appendix XI: Showing health facilities that received in excess of their orders. ................. 48
Appendix XII: Showing health facilities that planned did not order but received. .............. 50
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Table 1: Funding of EMHS and ARVs .................................................................................... 4
Table 2: Sampled Health Facilities (HF) per tier .................................................................. 7
Table 3: Selected HC IIs & IIIs ............................................................................................... 8
Table 4: Methodology used .................................................................................................... 8
Table 5: Comparison between NMS supplier prices and the median international
supplier prices ........................................................................................................ 15
Table 6: Showing the range by which Donated ARV Prices were found to be lower .......... 17
Table 7: ARVs quantities procured and donated over a period of three years ................... 18
Table 8: Showing the price comparison of NMS average purchase prices and the
WHO international median prices ......................................................................... 19
Table 9: Showing variations between contract prices and actual purchase prices ........... 20
Table 10: Showing percentage variances between NMS, MARKET and JMS prices
in Uganda shillings................................................................................................. 22
Table 11: Showing statutory mark-up for EMHS, ARVs and ACTs ...................................... 23
Table 12: Showing planned, ordered but not issued quantities over a period
of time ..................................................................................................................... 25
Table 13: Showing planned, ordered but issued less quantities over a period of time ..... 25
Table 14: Showing reduction in purchasing power due to exchange rate losses over
the years ................................................................................................................ 26
Table 15: Comparison between the contract prices and the NMS procurement plan
prices.......................................................................................................................27
Table 16: Extra cost incurred due to changes in procurement plan/order prices and
issue prices to Health Facilities ........................................................................... 28
Table 17: Showing unplanned, not ordered but issued quantities over a period of time .. 29
Table 18: Showing planned, ordered but issued quantities in excess over a
period of time ....................................................................................................... 29
Table 19: Showing planned, not ordered but issued quantities over a period of time ....... 30
Table 20: Showing average LATE and EARLY deliveries ..................................................... 31
Table 21: Showing average LATE and EARLY orders........................................................... 31
LIST OF TABLES
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Figure 1: Showing 2013 price comparisons with the donor supplies................................ 16
Figure 2: Showing 2014 Price Comparison with the donor suppliers ................................ 16
Figure 3: Showing 2015 price comparisons with the donor supplies ................................ 17
Figure 4: Showing drugs above and below the statutory markup charge ......................... 23
Figure 5: Showing Average Late and Early Deliveries made by NMS ................................ 31
Figure 6: Showing Average Late and Prompt Orders made by NMS ................................. 32
LIST OF FIGURES
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LIST ABBREVIATIONS
ACT Anti-Malarial Artemisinin Combination Therapies
AMC Average Monthly Consumption
ARV Anti-Retroviral Medicines
CCA Customer Care Assistant
CQCIL Cipla Quality Chemicals Industry Limited
EMHS Essential Medicines and Health Supplies
ERP External Reference Pricing
GH General Hospitals
HC Health Center
HF Health Facility
IDIPG International Drug Indicator Price Guide
IMT Inventory Management Team
JMC Joint Medical Stores
MOH Ministry of Health
MSD Medicine Stores Department
MSH Management Science of Health
NDA National Drug Authority
NDP National Development Plan
NMS National Medical Stores
PDU Procurement Disposal Unit
PPDA Public Procurement and Disposal Authority
RRH Regional Referral Hospital
SRA Stringent Regulatory Authority
WHO World Health Organization
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Over the years government has emphasized the importance of efficient and appropriate procurement, storage and distribution of essential medicines and health supplies (EMHS) at all levels of the health management system to ensure effective nationwide delivery of the Uganda National Minimum Health Care Package.
National Medical Stores (NMS) was set up by the National Medical Stores Act 1993 (Cap 207) as an autonomous body responsible for procurement, storage and distribution of essential medicines and health supplies (EMHS), to all Public Health Facilities in the Country.In 2010 the Office of the Auditor General (OAG) undertook a value for money audit on the Procurement and Storage of drugs in which a number of shortcomings were observed such as failure to meet customer requirements, lack of proper procurement plans, lack of a clear coordination mechanism with third parties in the area of procurement, and improper handling of expired drugs.
Following public concerns, in 2016 the OAG undertook a risk assessment which revealed that the health sector still faced challenges regarding drug pricing and deliveries to health facilities by NMS. Furthermore, an evaluation of the basic kit system in 2013 by the National Pharmaceutical Sector revealed that the majority of health facilities were either over or under supplied. The report further observed that although NMS had implemented district-specific kits for each of these levels of care to better match specific needs, procurement planning remains a challenge at health facility level.
It is against this background that OAG decided to conduct a value for money study to assess the extent to which NMS efficiently delivers EMHS in the right quantities at reasonable prices to public health facilities in Uganda.
KEY AUDIT FINDINGSDRUG PRICINGTo assess the reasonableness of prices charged to Health facilities, comparisons were undertaken between NMS prices and international and local market prices as observed below:
International Reference Prices Vs NMS Supplier Prices 1) NMS procured all the thirteen (13) selected national tracer drugs at relatively lower prices
compared to the International Reference prices. 69% of these drugs were procured at prices lower than the international prices by at least 50%.
2) It was observed that in the majority of cases, the prices at which NMS procured Anti-Retroviral medicines (ARVs) from the approved local manufacturer during the period under review were higher than the donated drug prices. The high prices mean fewer quantities are procured for distribution to health facilities with the available resources. This can result in increased donor dependency which exposes government to a risk of
EXECUTIVE SUMMARY
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limited availability of ARVs in the event of withdrawal or expiry of donor funding. 3) It was noted that 73% of the fifteen (15) selected most-frequently ordered anti-cancer
drugs were procured at a relatively higher price compared to the international median prices. Seven (7) out of the fifteen (15) were procured at prices relatively higher than the international prices by at least 100%.
NMS prices Vs Joint Medical Stores (JMS), and Local Market prices for EMHS• It was observed that out of the thirteen (13) selected EMHS drugs, 77% were issued
by NMS to health facilities at lower than the average market prices. Additionally, 92% were issued at a relatively lower prices compared to Joint Medical Stores prices.
Mark-up Charges• Significant variations were noted in the rates applied on the drug purchase prices in
respect of handling fees to derive the issue prices to the health facilities. This impacted on the price charged to the health facilities.
PLANNING AND DELIVERY OF EMHS 1) It was noted that owing to the budget constraints experienced by NMS and price variations,
94% of the selected seventy two (72) health facilities did not receive EMHS quantities as planned and ordered for in 2013/14 and 2014/15. 53% of the facilities did not receive the drugs that were planned and ordered for in the FY 2015/16. Furthermore, 93% received less EMHS quantities than were ordered for during the three year period under review.
2) 94% and 90% of the selected seventy two (72) health facilities received EMHS quantities that had neither been planned nor ordered for in 2013/14 and 2014/15 respectively.
3) Over 90% of the seventy two (72) selected health facilities received EMHS quantities in excess of what had been ordered for during the 3 years under review.
TIMELINESS OF EMHS DELIVERIES Whereas efforts were made to deliver EMHS in time, cases of delays were noted. Consequently, stock-outs of essential medicines and health supplies averaging (9-15) days were experienced by the selected health facilities thereby hampering service delivery.
KEY RECOMMENDATIONS1) The Ministry of Health should work closely with the local company to ensure that the
objectives of the Memorandum of Understanding (MoU) to provide low cost pharmaceutical products are achieved. This will require compliance by government to the terms of agreement that give exclusive rights to the local manufacture for purchase of Anti-Malarial Artemisinin Combination Therapies (ACTs) and Anti-Retroviral Medicines (ARVs) since it was envisaged that increased economies of scale would drive prices down.
2) Procurement of anti-cancer drugs should be opened up to all National Drug Authority (NDA) approved manufacturers/suppliers. Drugs on the NDA register should only be rejected if it can be demonstrated that they are of inferior quality. In addition, NMS should co-opt subject matter specialists (UCI and NDA representatives) on the evaluation committee for the procurement of anti-cancer medicines. The procurement of SRA approved drugs should be undertaken in consultation with NDA.
3) NMS should apply the 8% and 7% statutory mark up for EMHS and ARVs, respectively as provided for in the approved annual budgets and as required by the Entity’s Financial Reporting Framework.
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4) NMS should ensure that the survey reports and procedures are comprehensively reviewed to ensure accuracy.
5) NMS should ensure that the prices communicated to health facilities at the planning stage reflect the running contract prices.
6) NMS should engage MoFPED and MoH to agree on a framework for bridging the financing gaps caused by volatility in exchange rates.
7) Changes in treatment policy and item specification should be properly planned and communicated in order not to impact on the procurement and supply chain.
8) MoH should ensure that arrangements for supplies of emergency drugs are done in full consultation with NMS and the beneficiary health facilities to enable proper planning of procurement and utilization.
9) Procurement planning should be undertaken based on the disease burden other than the average monthly consumption so as to ensure the accuracy of planned drug quantities.
10) NMS should automate the processes of planning, ordering, receipting, storage, distribution and delivery of orders so as to improve on timeliness of drug deliveries.
11) NMS should promptly resolve customer complaints in a timely fashion.
OVERALL AUDIT CONCLUSION
Whereas NMS purchased EMHS at lower prices relative to international market prices, anti-cancer drug prices were found to be on the higher side. Similarly, ARVs prices were found to be higher than the donated drug prices. Further in comparison with market prices NMS prices for EMHS were found to be generally lower than those of comparable providers. However, the excessive charge for the handling fees impacted on the prices charged to health facilities.
Therefore, except for ARVs and anti-cancer drugs, EMHS drug prices were found to be generally reasonable for the sampled drugs.Overall, health facilities experienced discrepancies in delivered quantities during the period under review.Whereas efforts were made by NMS to deliver EMHS in a timely fashion, cases of delays were noted.
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INTRODUCTION
1.1 BACKGROUNDNational Medical Stores is mandated to procure, store and distribute Essential Medicines and Medical Supplies to all Public Health Facilities in the Country, including those of the Police, Army and Prisons. This includes all Medicines directly or indirectly procured by NMS and those that are donated by various donors. In August 2012 this mandate was further expanded to include distribution of Vaccines across the country. National Medical Stores receives funds from the Government of Uganda for procurement and storage of Essential Medicines and Health Supplies (EMHS), and their distribution to the various health facilities countrywide. The Management of NMS is accountable for these funds under the purview of the Public Finance Management Act, 2015 and the NMS Act, 1993.For the financial year 2015/16, over UGX.219 billion was budgeted and allocated to NMS for procurement of essential medicines and health supplies to all Health Facilities.
1.2 MOTIVATIONIn 2010 the Office of the Auditor General (OAG) undertook a value for money audit on the Procurement and Storage of drugs and observed the following matters: failure to meet customer requirements, lack of proper procurement plans, lack of a clear coordination mechanism with third parties in the area of procurement, and improper handling of expired drugs. Following public concerns, in 2016 the OAG undertook a risk assessment which showed that the health sector still faced challenges regarding drug pricing and deliveries to health facilities by NMS.An evaluation of the basic kit system in 2013 by the National Pharmaceutical Sector revealed that the majority of health facilities were either over or under supplied. The report further observed that although NMS had implemented district-specific kits for each of these levels of care to better match specific needs, procurement planning remains a challenge at health facility level1.
It is against this background that OAG decided to carry out an audit on management of procurement and distribution of Essential Medicines and Health Supplies.
1 National Pharmaceutical Sector Strategic Plan 2014-2020 Page 4.
CHAPTER ONE
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1.3 DESCRIPTION OF THE AUDIT AREA
1.3.1 General DescriptionMedical supplies are a key input for the efficient operation of Health Facilities. Uganda currently has 2,941 Health facilities distributed in the various regions. The Facilities include Hospitals, HC IVs, HC III and HC II. National Medical Stores (NMS) is mandated to procure, store & distribute Essential Medicines and Medical Supplies to all these Facilities including the police, army and prisons.
The medicines are distributed to all the Government hospitals and health centers on a routine basis against the orders made to them by the health facilities. All medicines and medical supplies are also embossed by NMS with a seal “UG NOT FOR SALE” to ensure that medicines and medical supplies delivered are not stolen and sold on the open market.The “LAST MILE DELIVERY SYSTEM” is used for medicines and other medical supplies to ensure that medical supplies reach the END USER at all government health facilities across the country safe and on time. Medicines and other medical supplies Delivery Schedules are published to make the delivery of medicine predictable throughout the year. NMS ensures effective Management of stock so that health facilities do not run out of medicines and other medical supplies.
Basic Kits which contain the basic Medicines are supplied to all health center IIs and IIIs across the country. The kit is revised every year to make it relevant to the local situation and delivery is done once in every two months to all government health centers IIs and IIIs. HC IVs and hospitals submit their medicine orders and these are supplied to them once in two months (Bi- Monthly) as per delivery schedule.
1.3.2 Mandate, Vision and Mission of NMSMandate National Medical Stores is mandated to Procure, Store and Distribute Essential Medicines and Medical Supplies to all Public Health Facilities in the Country.
VisionThe NMS vision is, “a population with adequate and accessible quality medicines and medical supplies”.
MissionThe NMS mission is, “to effectively and efficiently supply essential medicines and medical supplies to Public Health Facilities in Uganda”.
1.3.3 ActivitiesThe major activities of NMS are:i) Procuring Drugs;ii) Storage of drugs; iii) Distribution of drugs to health facilities; andiv) Advisory responsibility on essential issues relating to the state of the Corporation and
its future development as well as to related matters including the estimation of drug needs, distribution and use of medicines in the public health service.
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1.3.4 Organizational StructureNMS is a Government Corporation supervised by the Minister of Health. NMS has a Board of Directors comprising a non-executive chairperson, 15 non-executive members and the General Manager (GM). Under the GM are 7 Heads of Departments namely: Corporation Secretary (who is slightly above the rest in hierarchy); Stores and operations, Sales and Marketing, Finance and Accounts, Internal Audit and Human Resource and Support Services. Whereas Quality Assurance is under the Corporation Secretary, Management information system and Public Relations are under the GM’s office. Details of the organization structure are in Appendix III.
1.3.5 FundingNMS obtained and fully utilized funding amounting to UGX 655.9bn for three financial years; 2013/14; 2014/15; 2015/16 as indicated in the Table 1 below:
Table 1: Funding of EMHS and ARVs
2013/14 (UGX) in millions
2014/15 (UGX) in millions
2015/16 (UGX) in millions
Vote Output RELEASE EXPENDITURE RELEASE EXPENDITURE RELEASE EXPENDITURE
Supply of EMHS to HC II (Basic Kit) 11,163 11,163 11,163 11,163 11,163 11,163
Supply of EMHS to HC III (Basic Kit) 18,360 18,360 18,360 18,356 18,360 18,360
Supply of EMHS to HC IV 7,992 7,992 7,992 7,992 7,992 7,992
Supply of EMHS to General Hospitals 18,106 18,106 13,106 13,105 13,106 13,106
Supply of EMHS to Regional Referral Hospitals
13,024 13,024 13,024 12,984 13,024 13,024
Supply of EMHS to National Referral Hospitals
12,365 12,365 12,365 12,365 12,365 12,365
Supply of ACTs and ARVs and Anti TB drugs to Accredited Facilities
100,000 100,000 99,535 99,532 100,000 100,000
Supply of EMHS to Specialized units. 27,863 27,863 17,955 17,957 18,103 18,103
Supply of Emergency and Donated Medicines
2,500 2,500 2,500 2,490 2,500 2,500
Supply of Reproductive Health Items 8,000 8,000 8,000 7,994 8,000 8,000
Immunization Supplies 9,000 9,000 9,000 9,000
Laboratory Items 5,000 4,999 5,000 5,000
Totals 219,374 219,374 218,002 217,941 218,614 218,614
Source: IFMS Releases and Expenditure files
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1.4 AUDIT OBJECTIVESOverall Audit Objective: To assess the extent to which NMS efficiently provides EMHS in the right quantity at reasonable prices to public health facilities in Uganda.
Audit Questionsi) To what extent does NMS supply EMHS at reasonable prices?ii) To what extent does NMS deliver the right quantities of EMHS to the health facilities?iii) To what extent are EMHS delivered to health facilities in a timely manner?
1.5 AUDIT SCOPEThe audit focused on the procurement and distribution of Essential Medicines and Health Supplies (EMHS) by National Medical Stores (NMS) to government owned health facilities and specifically assessed whether NMS provided EMHS to these health facilities in a timely manner, at the right quantity and at a reasonable price over the three financial years; 2013/14, 2014/15 and 2015/16.
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2.0 AUDIT METHODOLOGYThe audit was conducted in accordance with the International Organization of Supreme Audit Institutions(INTOSAI) Performance Auditing Standards and the Value for Money Auditing guidelines prescribed in the Office of the Auditor General (OAG) VFM audit manual. The standards require that the audit is planned in a manner which ensures that an audit of high quality is carried out in an economic, efficient and effective way and in a timely manner.
2.1 SAMPLINGThe audit scope covered all government owned health units in the country with various tiers, that is, Regional Referral Hospitals, General hospitals and Health Centre IVs. A two – stage stratified sampling methodology was adopted. In the first stage, the population was stratified into the various tiers as stated earlier. At the second stage, units within each tier were stratified according to the variance in the quantities of medicines received against the quantities ordered.
Sample Size determination72 out of 238 Health Facilities (HC IVs, General Hospitals and Regional Referrals) were selected using simple random sampling.
Table 2: Sampled Health Facilities (HF) per tier
Tier No. of HF Sample
Regional Referral Hospitals 13 7
Hospitals (District & Military) 46 13
Health Centre IVs 179 52
TOTAL 238 72
An additional 47 Health Facilities (IIs and IIIs) were selected for purposes of assessing timeliness taking into account ‘Last Mile’ deliveries according to the five (5) Delivery Zones as shown in Table 3.
CHAPTER TWO
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Table 3: Selected HC II & IIIs
Delivery Zone HC II HC IIIZone 1 6 6
Zone 2 4 6
Zone 3 4 7
Zone 4 6 6
Zone 5 1 1
Total 21 26
A list of tracer drugs was obtained from MOH and a sample selected basing on level of importance. Twenty one (21) out of the forty one (41) tracer drugs were selected. The sample included 13 EMHS which are a must have at the different health care levels and 8 ARVs and ACTs.
2.2 DATA COLLECTION METHODSThe data collection methods used to answer each audit question involved document review, conducting interviews and physical inspections as shown in Table 4 below:
Table 4: Methodology usedAudit Questions Methodology used
Qn 1: To what extent does NMS supply EMHS at reasonable prices?
The team reviewed the National Medicines Policy 2015 to gain an understanding the policy framework governing drug pricing. The WHO pricing guidelines were also reviewed to obtain benchmark to be used for price comparisons. Using the bench marks, the following price comparisons were undertaken on selected EMHS, ARVs and anti-cancer drugs to establish variances and their effect on the issue prices to the Health Facilities:
• WHO International Reference Prices Vs NMS Procurement prices
• NMS Issue Prices Vs JMS and Local Market Prices
Annual Approved budgets and IFMS financial records were also reviewed to establish whether NMS correctly applied the stipulated rates to arrive at handling fees deductible from the quarterly releases.
Reviewed the purchase documents to establish whether NMS consistently applied the correct handling fee rates for the different drug categories (EMHS & ARVs) over the period under review.
Qn 2: To what extent does NMS deliver the right quantities of EMHS to the health facilities?
Heads of departments at NMS were interviewed to gain an understanding of the drug supply chain processes and the causes of discrepancies that were being raised by the health facilities. Persons interviewed are detailed in Appendix II
Procurement plans submitted by the sampled Health Facilities were also reviewed to ascertain how NMS develops its consolidated Annual procurement plan. Dispatch records were matched with orders and procurement plans to assess extent of order fulfillment by NMS.
This was corroborated with interviews with the selected Health Facility in-charges. Details of the reviewed documents and purpose for the review can be seen in Appendix I.
Qn 3: To what extent are EMHS delivered to health facilities in a timely manner?
The NMS Customer charter was reviewed to establish the expected relationship between NMS and Health Facilities with regard to timeliness of services.
Delivery and order schedules were reviewed to assess the timelines set by NMS and whether both parties had adhered to these timelines during the period under review. Head of Stores and the Sales and Marketing Manager were interviewed to ascertain causes of delayed delivery of drugs to Health Facilities.
The health facility in-charges were also interviewed to establish whether orders are submitted to NMS in time and whether deliveries are done in a timely fashion.
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CHAPTER THREE
3.0 SYSTEMS AND PROCESS DESCRIPTION
3.1 ROLES AND RESPONSIBILITIES OF KEY PLAYERS
Ministry of HealthMinistry of Health (MOH) is responsible for; • Providing policy and communication of future policy changes relating to the procurement
and distribution of medicines and health supplies.• Communicating timely to the districts the budgetary allocations of funds to be disbursed
to NMS for the procurement of the EHMS. • Providing a list of all accredited government Health Facilities that NMS shall provide
Medicines and other Health Supplies.• Providing NMS with the approved list of Medicines, health supplies and laboratory
reagents, according to the level of care from which health facilities shall be obliged to make their orders.
• Coordinating and organizing medicine donations and timely communicating to NMS for proper storage and distribution.
• Approving service/handling charges raised by NMS to third party providers of medicines and other health supplies.
• Advising Parliament through MoFPED on allocation of adequate resources for each health facility to enable NMS procure and distribute appropriate medicines and other health supplies for health facilities.
NMS BOARDThe functions of the board are to2:• Formulate and review the policies of the corporation having regard to its purposes as
set out in this Act; • Set targets for the annual performance of the corporation both in terms of public service
and financial results; • Appraise and evaluate the performance of the management of the corporation; • Make recommendations to the Minister regarding the appointment, performance
and dismissal of the general manager of the corporation and the terms of his or her appointment;
• Appoint, appraise and discipline senior members of the staff of the corporation; • Determine the organisational structure and staffing of the corporation; • Establish its NMS own operational procedures.
2 NMS_ACT_1993 PART II
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NMS Sales and Marketing DepartmentIt is a customer facing department in NMS that handles ; Planning; Needs assessment; Quantification; Order receipt entry and management; Complaint and Feedback Management; Operational Customer Focused Research; Customer Capacity Building and Monitoring and Evaluation3.
NMS Stores and Operations DepartmentThe main objective of the department is, “To acquire, store and distribute Essential Medicines and Health supplies in the right quantity of the right quality to all health facilities countrywide effectively and efficiently4. The department is made up of 3 Sections that is the Stores, Transport, and Vaccines & Cold Chain. The main responsibility of the department is to deliver Essential Medicines and Health Supplies (EMHS) to all 2,941 Health facilities in the country and maintain a stock list approximately 3,000 SKUs.
NMS Procurement DepartmentThe general objective of the department is, “To efficiently and effectively procure quality and affordable trading and non-trading supplies, works and services”. The scope of trading stock include: Medicines, Hospital Sundries and Consumables, Hospital Equipment, Antiseptics & Disinfectants; Orthopedic supplies; Edible and IV Nutritional supplements, Laboratory and Diagnostic products, Hospital Stationary and Dental supplies. The main responsibilities of the department are:• Developing procurement plans for
each financial year• Maintaining an updated pre-
qualified suppliers database, and
3 NMS Strategic Plan 2015/16-2019/20
4 Stores_and_operations_manual_version 1.2
update it periodically• Monitoring and evaluating management of
contracts by Contract Managers• Ensuring the safety and accessibility of
Procurement documents for review and audit purposes
• Build and Maintain supplier relations• Preparing and disseminating reports and
communication in a timely• Appropriate disposal of out of use supplies
Health Facilities Health facilities order for drugs and medical supplies from NMS offices. They have a great influence on the supply chain due to the role they play to enhance accuracy in forecasting their needs as well as timely preparations and submission of their orders to NMS.
3.2 PROCESS DESCRIPTION
Product Selection:Ministry of Health develops Clinical Guidelines and the Essential Medicines and Health Supplies List of Uganda (EMHSLU). The EMHSLU forms a basis by which NMS procures EMHS.
Quantification:NMS then sends out the list to all health care facilities as a basis for planning and quantification. Quantification is then done according to the needs of each health facility with technical assistance from MOH-Pharmacy Division and NMS Sales and marketing department. The Sales and Marketing Department then acts as the steering group and provides specialist support as required throughout the quantification and drawing up of procurement plans according to the Clinical Guidelines, EMHSLU, Morbidity Patterns and the available budget. This is then amalgamated to inform the NMS procurement plan5 which is approved by the Board of Directors before onward submission to the Permanent Secretary/ Secretary to Treasury (PSST) and PPDA as prescribed by law.
5 Interviews with various health center in-charges and the NMS
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Procurement:On approval of the procurement plan, the procurement process as prescribed by PPDA takes off. The User Department initiates the procurement process for EMHS that do not have running contracts by raising the PPDA Form 5. The prices for EMHS on the Form 5 are informed by the Previous procurement prices; Quotations from potential bidders and/or Market surveys. The procurement process concludes by handing over all the valid contracts to the user department for contract management.
Inventory Management and Storage:Call off, Receipt and Warehousing of EMHS is done according to the Stores and Operations Policies and Procedures Manual. For GOU procured EMHS, on receipt, the NMS Accounting system computes the price by applying a handling fee of 8% on essential medicines and health supplies and 7% on ARVs on the weighted average cost. This is the price at which NMS supplies to health facilities throughout the country. For donated EMHS, NMS supplies to facilities at no cost but charges handling fees appropriately.
Delivery of drugs to health facilities:After the drugs have been procured and received in the NMS stores, they are then delivered based on orders from the health facilities.
The Orders for drug supply are of 2 types:• Pull orders – Originated by customers
according to their own needs by email, fax, post or physically.
• Push orders – These orders are originated by MoH and third parties specifying the quantity of drugs and medical supplies to be delivered to each specified district and health units.
These orders are received by the Customer Care Assistant (CCA) who checks the orders to for authenticity. Once verified, the CCA records the orders in the order tracking book. The office clerk then categorizes and files orders according to districts and regions. The sales and marketing officer allocates the filed orders to the sales assistants (SA) for encoding according to delivery schedule and order type. The SA then checks the orders to the facility procurement plan whether
item codes, item descriptions and quantities are accurately captured. The SA then saves and prints the order confirmation. The order confirmations are then sent to the officer clerk for sorting, filing and recording by district. An order tracking summary report is then prepared by the office clerk and later reviewed by the sales and marketing officer.
The Sales and Marketing officer then releases the orders for processing and sends the order summary report to the finance clerk who receives and signs on receipt of the sorted, files order confirmation. At this point, Physical files containing original orders and order confirmations are sent to dispatch section where the dispatch clerk creates journeys for encoded released orders. The stores assistant then creates a picking list for the journey, prints them out and distributes them to pickers in the picking zones on a First in First Out basis.
The picker parker then confirms that the stock on the location matches the picking list in terms of product, description, unit measure, and expiry date and batch numbers. Once confirmations have been done, items are then packed in boxes and sent to the marshalling area.
The Marshalling Area attendant receives the packed consignments and verifies the number of boxes packed against each picking list. He then arranges consignments by journey in the marshalling area. The marshalling area attendant then informs the dispatch assistant to print the delivery notes and physically hand over a complete journey to him. The dispatch clerk then confirms the consignment is in line with the delivery documents. Drugs are then released for delivery to the health facility according to the planned journeys as indicated in Appendix IV. In the case of discrepancies, discrepancy notes are raised by the health facilities and sent to NMS.
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4 FINDINGS, CONCLUSIONS AND RECOMMENDATIONS
In an effort to promote service delivery in the health sector across the country, government mandated NMS to procure, store and distribute Essential Medicines and Health Supplies (EMHS) to all public health facilities in the country.Despite efforts by government to enhance service delivery in the health sector, challenges still exist for NMS to deliver these drugs in the right quantities and at reasonable prices to the health facilities as detailed in the findings below.
4.1 DRUG PRICING The National Medicines Policy 2015 aims at ensuring efficient and cost effective use of the limited available resources in the supply and distribution of Essential Medicines and Health Supplies to the health facilities6. The policy emphasizes use of cost effective measures to ensure reasonable pricing of drugs. To assess the reasonableness of drug pricing, the following price comparisons were undertaken;
4.1.1 Comparison of International and Local Market prices with NMS pricesThe WHO pricing guidelines, external reference pricing (ERP), also known as international reference pricing 2014, recommends using the price of a pharmaceutical product in one or several countries to derive a benchmark or reference price for the purposes of setting or negotiating the price of the product in a given country. The guidelines note that the use of ERP can be helpful for the aspects of price negotiation, and verification7.A comparison between the NMS purchase prices, international prices and licensed NDA market supplier prices revealed variations as explained below:a) International Reference Prices Vs NMS Supplier Prices i) EMHS PricesThrough document review, audit noted that NMS used the WHO pricing guidelines in the market surveys undertaken during the procurement process. This was visibly seen from a comparison of the prices of the national tracer medicines which revealed that NMS procured drugs at relatively lower prices compared to the international reference prices as indicated in the Table 5 below:
6 National medicines policy 2015, Guiding principles and focus areas: principle 2 (Equity and Efficiency)
7 WHO guidelines on pharmaceutical, pricing, 2015, page 15
CHAPTER FOUR
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Table 5: Comparison between NMS supplier prices and the median international supplier prices
SN Medical Supply Strength Packaging
Average NMS
Supplier Prices (USD)
MSH/WHO
prices (USD)
%age Below WHO
Prices
1 Artemether+ lumenfatrine 20mg/120mg 30 Tab 52.1 63.49 22
2 Amoxicillin 250mg 1000 Capsule 15.28 20.6 35
3 Diazepam 5mg 1000 tab 3.42 9.6 181
4 Salbutamol 4mg 1000 tab 1.68 3.8 126
5 Folic acid 5mg 1000 Tab 3.46 3.6 4
6 Ibuprofen 200mg 1000 tab 3.87 7.7 99
7Magnisium Trisilicate comp
250+120mg 1000 tab 2.43 4.585
8 Erythromycin 250mg 1000 Vial 25.2 43.8 74
9 Paracetamol 500mg 1000 tab 3.34 5 50
10 Cotrimoxazole 100 mg 6 pessary 0.22 0.7 218
11 Ciprofloxacin 500mg 100 Tablet 2.49 4.8 93
12Oral Rehydration salts
1ltr 25 1.22 3146
13 Vitamin A 200,000 IU 1000 Capsule 47.52 62.5 32
Source: OAG analysis of Average supplier prices to NMS for 2015/16
The above table indicates that all the 13 sampled drugs were procured at prices lower than the WHO international reference prices.
ii) ARVs and ACTs PricesThe National Medicines Policy, 2015 emphasizes the development of a viable national domestic pharmaceutical industry with the potential to serve public health needs, support economic and industrial development, and promote national self-sufficiency by creating a business model in which sufficient economies of scale can be achieved to justify the investment in good quality production, and still achieve competitive prices. To promote local pharmaceutical production, government supported the establishment of a local pharmaceutical manufacturing company. Currently ARVs and ACTs are supplied to NMS by the donor community and the company.
The company has increased foreign exchange inflows through export of medicines and has brought about increased foreign exchange savings on imports as the country now buys its ARVs and ACTs locally8. Despite this and many other national benefits, it was observed that in the majority of cases, the prices at which NMS procured ARVs from the local manufacturer during the period under review were higher than the prices of drugs imported under donor supported arrangements as illustrated in the Figure 1, Figure 2, Figure 3 and table 6 below:
8 Untangling the web of antiretroviral price reductions 17th according to part 2 section 3
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Key for ARV’ Drugs
Full Name of drug Short name
1. Artemether 20mg+lumefantrine 120mg(strip of 24) AL
2. Efavirenz 600mg tab E 600
3. Efavirenz 200 mg cap E 200
4. Lamivudine150mg + zidovudine 300 mg tab, LZ
5. Lamivudine150mg+zidovudine300mg+nevirapine200mg t LZN
6. Nevirapine 200mg tab N 200
7. Tenofovir/lamivudine 300mg/300mg tablets TL
8. Tenofovir/lamivudine/efavirenz 300mg/300mg/600mg TLE
Figure 1: Showing 2013 ARVs drug price comparisons with the donor supplies
Source: OAG analysis of NMS receipt data
Figure 2: Showing 2014 ARVs drug Price Comparison with the donor suppliers
Source: OAG analysis of NMS receipt data
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Figure 3: Showing 2015 ARVs drugs price comparisons with the donor supplies
Source: OAG analysis of NMS receipt data
Table 6: Showing the average range by which Donated ARVs Prices were found to be Lower.
ARV DRUG
Local Manufacturer DonatedAverage
Percentage Difference
2103 2014 2015Average
(USD)2013 2014 2015
Average
(USD)
Average Price Difference
(USD)
Average Percentage Difference
AL 52.7 52.1 52.1 52.3 39.7 31.2 28.6 33.17 19.13 37
E 600 6.8 6 6 6.27 3.6 4 3.4 3.67 2.6 41
LZ 9.5 6.7 9.5 8.57 7.3 7.6 7.4 7.43 1.14 13
LZN 13.9 8.8 11.9 11.53 9.2 9.3 9.1 9.2 2.33 20
TL 8.6 5.5 7.7 7.27 5.3 5.2 5.2 5.23 2.04 28
Source: OAG Analysis of Average ARV Prices
The table above shows that the donor prices for five (5) out of the eight (8) selected drugs were on average lower than those of the local supplier prices. The percentage average difference for three (3) out of the five (5) drugs was found to be more than 25%.
It was noted that the local manufacturer’s prices were dictated by the MoU that was signed between MoH on behalf of GoU and the company. Whereas the MoU9 provided for negotiation10 of prices (Article 6.2) and procurement of all ARVs from the local manufacturer by government and Related Agencies (Article 3.1.1), it was not fully executed in this regard11 as government continued to procure ARVs from multiple sources. These provisions in the MOU were aimed at attainment of economies of scale that would drive down the prices as a result of reduced unit costs of manufacturing the drugs.
9 Evaluation methodology and criteria, sub-section 6.3 of the standard bidding documents.
10 2014 http://www.nda.or.ug/ug/smenu/61/human-drugs-register-august-2016.html
11 CIPLAQCIL/EC/16-231 dt 22/April/2016
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The high prices mean fewer quantities are procured for distribution to health facilities with the available resources (refer to table 7 below). This can result in increased donor dependency which exposes government to a risk of limited availability of ARVs in the event of withdrawal of donor funding. The Table 7 below shows a comparison of the drug quantities procured by NMS and the donors.
Table 7: ARVs quantities procured and donated over a period of three years
Item
2013/14 (Packets) 2014/15 (Packets) 2015/16 (Packets)
Quantity bought
Donor input
Quantity bought
Donor input
Quantity bought
Donor input
Artemether 20Mg+Lumefantrine 120Mg(Strip Of 24)
303,476
59,099
534,437
110,719
215,444
330,956
Efavirenz 600Mg Tab 517,843
596,683
178,234
680,267
664,689
1,723,946
Efavirenz 200 Mg Cap 19,067
106,519
-
72,485
-
68,565
Lamivudine150mg + Zidovudine 300 Mg Tab,
608,893
305,219
382,132
221,294
29,204
546,544
Lamivudine150mg+Zidovudine300mg+Nevirapine200mg T
1,228,945
1,314,081
796,741
1,109,908
356,019
1,228,040
Nevirapine 200Mg Tab 53,438
174,857
-
443,179
25,613
534,035
Tenofovir/Lamivudine 300Mg/300Mg Tablets
418,141
196,883
1,140,460
354,275
623,678
1,038,444
Tenofovir/Lamivudine/Efavirenz 300Mg/300Mg/600Mg
-
1,558,129
88,658
1,774,845
156,554
2,905,176
Totals 3,149,803 4,311,470 3,120,662 4,766,972 2,071,201 8,375,706
Percentage Of Donor Quantities To The Total Supplied Quantities
42% 58% 40% 60% 20% 80%
Source: OAG Analysis of quantities purchased and those donated to NMS
As indicated in the table 7 above, donor dependency on ARVs has increased over the years under review. Additionally, the percentage of quantities of ARVs donated has increased from 58% to 80% of the total ARV supplies.
Management ResponseAlthough the report indicates that NMS was procuring these products at prices higher than those of donors, it should be noted that our procurement prices were well within the range of indicative international prices as provided in both the MoU and the price reference guide.NMS carries out negotiations with Cipla Quality Chemicals Limited to bring the prices within the acceptable pricing mechanism under the MOU.
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Audit CommentThe fact that the donor prices are lower implies that opportunities still exist for NMS to procure ARVs at a lower price.
iii) Anti-Cancer Drug PricesThrough document review and analysis, it was observed that 11 out of the 15 most frequently ordered anti-cancer drugs were procured at a relatively higher price than the international median prices as indicated in Table 8 below.
Table 8: Showing the price comparison of NMS average purchase prices and the WHO international median prices
S/N DRUG UGX MSH prices (2015 BOU average exchange rate) (A)
UGX NMS prices(2015 BOU average exchange rate) (B)
%age
ABOVE MSH price
%age
BELOW MSH price
1 Paclitaxel 100Mg Vial 39,615.37 141,161.24 256
2 Oxaliplatin Inj 5Mg/Ml 10Ml Vial 144,935.04 127,389.41 12
3 Cisplatin Injection Bp 50Mg/100Ml 26,110.88 97,952.13 275
4 Doxorubicin Hydrochloride 50Mg Vial 126,425.71 75,745.05 40
5 Docetaxel 40Mg/Ml 2Ml Vial 416,460.08 223,792.21 46
6 Carboplatin 10Mg/Ml, 45 Ml Vial 136,313.55 234,981.82 72
7 L-Asparaginase 10,000Iu Vial 56,713.76 299,537.26 428
8 Dacarbazine 200Mg Vial 49,523.28 43,725.55 12
9 Rituximab 500Mg 50Ml Vials 307,125.82 5,821,000.00 1,795
10 Filgrastim 300Mcg/Ml 1Ml Vial 15,240.51 410,000.00 2590
11 Cyclophosphamide 1Gm Vial 39,047.38 51,644.36 32
12 Calcium Folinate 50Mg/5Ml Vial 9,201.07 80,737.34 777
13 Gemcitabine Hcl 1G In 25Ml Vial 99,669.70 154,933.07 55
14 Capecitabine 500Mg Tablets 657,636.74 1,360,300.00 107
15 Daunorubicin Hcl 20Mg Vial 82,866.30 115,993.22 40
Source: OAG Analysis of purchase prices for the year 2015/16
The table 8 above shows significant variations between NMS and international median prices with 7 out of the 15 selected drugs having been procured at prices higher than 100% of the international prices.
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The high purchase prices of the anti-cancer drugs as compared to the WHO median prices were attributed to the Stringent Regulatory Authorities (SRAs)12 quality standards demanded by Uganda Cancer Institute (UCI). UCI insists that NMS procures for them SRA approved drugs. This disadvantages other competitors licensed by the National Drug Authority. A review of some of the SRA approved drug price lists shows that SRA approved drug prices are relatively more costly as compared to the median WHO prices/ non-SRA prices.
Furthermore, it was established that the price of some specialized drugs such as anti-cancer drugs is sometimes determined by the demand volumes. According to the global ecology trend report 2015, the global market size of anti-cancers was estimated to be USD 107bn in 201513 while the approved budget for UCI of UGX 7bn [equivalent to roughly to USD 2m per annum] representing roughly 0.002% in value of this global market. The very small market of Uganda could be unattractive to SRA-accredited Manufacturers who therefore target larger markets. Therefore, low supply volumes of SRA approved anti-cancer drugs could be attracting a high cost price to the country.
Furthermore, audit established that in some instances the high prices are also caused by variances in the contract price agreed in the framework contract and actual purchase price. (refer to appendix V). Out of the 15 sampled anti-cancer drugs, 3 drugs had their actual purchase prices higher than the contract price as indicated in the table 9 below:
Table 9: Showing variations between contract prices and actual purchase prices
S/N DRUG Procurement reference
Contract sign date
Contract price (USD)
2015 Purchase Price (USD)
Variance
1Doxorubicin Hydrochloride 50Mg Vial
NMS/SUPLS/14-15/00036 8-Jan-15 22 16.43 $5.57
2Filgrastim 300Mcg/Ml 1Ml Vial
NMS/SUPLS/14-15/00070
22-Jun-15 36 59.88 ($23.88)
3 Gemcitabine Hcl 1G In 25Ml Vial
NMS/SUPLS/14-15/00036 8-Jan-15 45 47.24 ($2.24)
4 Capecitabine 500Mg Tablets
NMS/SUPLS/14-15/00070
24-Apr-15 27 470.36 ($443.36)
Source: OAG Analysis of contract and purchase prices
12 The national drug regulatory authorities which are members or observers or associates of the International
Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH)
are considered as Stringent Regulatory Authority (SRA). http://www.stoptb.org/assets/documents/gdf/drugsupply/
List_of_Countries_SRA.pdf
13 Global Oncology Trend Report: A Review of 2015 and Outlook to 2020
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The Table 9 above and Appendix V shows that four (4) of the fifteen (15) anti-cancer drugs sampled had variances between the contract price and the actual purchase price. The price difference ranged between USD 443.36 and USD 2.24. Doxorubicin Hydrochloride 50mg vial with a price difference of USD 5.57 was the only drug that was procured at a price lower than the contract price.The high purchase prices also impact on the quantities purchased and delivered to the Health Facilities.
Management ResponseComparison of NMS purchase prices with those of the approved SRA price reference confirm that NMS was within the range. As established by the auditors, the market for anti-cancer medicines in Uganda Public Sector is 0.002% of the total global market which further reduces our purchasing power for SRA approved medicines.
Audit CommentWhereas NMS prices were within range as compared to SRA prices, NMS can still consider procuring drugs approved by WHO at lower prices.
b) NMS price Vs JMS, and Local Market prices for EMHSTo have a realistic comparison of market prices, NMS drug prices were compared with those of an organization with similar characteristics. JMS procures and issues drugs to non- government hospitals while NMS deals with government health facilities. For this purpose, JMS prices were used for comparison since NMS and JMS have comparable scales of operations. Another comparison was made with the average market prices obtained from three local pharmacies operating in Kampala. Through document review and analysis, it was observed that in majority of cases the NMS prices were lower than the average market prices and the JMS prices. Ten (10) out of the thirteen (13) selected drugs were issued at less than the average market prices while 12 out of 13 were relatively cheaper compared to JMS as detailed in Table 10 below.
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Table 10: Showing percentage variances between NMS, MARKET and JMS prices in Uganda shillings
SN Medical Supply Weight Packaging
NMS Average Issue Prices(A)
Average Market Prices (B)
JMS Prices (C)
%
Above Market price
(A-B)/B
%age Below Market Price
(A-B)/B
%age Above JMS
(A-C)/C
%age Below JMS
(A-C)/C
1 Artemether+ Lumenfatrine 20mg/120mg 30tabs 177,380 67,500 140,400 162 26
2 Amoxicillin 250mg 1000 Capsule 46,332 50,000 46,440 7 0.2
3 Diazepam 5mg 1000 tab 12,172 60,000 50,400 80 76
4 Salbutamol 4mg 1000 tab 6,021 20,000 30,990 70 81
5 Folic acid 5mg 1000 Tab 6,007 20,000 29,070 70 79
6 Ibuprofen 200mg 1000 tab 10,992 20,000 21,050 45 48
7 Magnesium Trisilicate comp 250+120mg 1000 tab 9,028 20,000 16,487 55 45
8 Erythromycin 250mg 1000 Vial 90,149 75,000 142,750 20 37
9 Paracetamol 500mg 1000 tab 12,420 25,000 17,490 50 29
10 Cotrimazole 100 mg 6 pessary 769 1,000 1,071 23 28
11 Ciprofloxacin 500mg 100 Tablet 8,896 8,000 9,585 11 7
12Oral Rehydration salts
1Ltr 25 4,533 6,500 5,915 30 23
13 Vitamin A 200.00I U 1000 Capsule 184,987 266,667 444,967 31 58%
Source: OAG analysis of NMS Average delivery prices for 2015/16 (Market prices were obtained from three different pharmacies)
Only three (3) out of the thirteen (13) selected EMHS drugs were issued at higher than the average market price and one (1) out of the thirteen (13) sampled EMHS drugs was issued at a relatively higher price compared to JMS prices.The cases of higher variations in price could be due to errors/omissions made in undertaking market surveys. For instance it was observed through review of the market survey documentation that the surveys for twelve (12) out of the thirteen (13) sampled drugs had computational errors in both the NMS quoted price and WHO-International Drug Indicator Price Guide(IDIPG) price used for comparison. Singular errors were also observed in the quoted JMS and Tanzanian comparative prices. These errors can lead to inaccurate market surveys resulting into inappropriate pricing decisions. (refer to appendix VI)
Management ResponseThe nearest market in Uganda to compare NMS procurements with should be JMS as any other market may have other considerations. There is only one drug that is higher than the market and JMS because the brand available at JMS (Lonart) is of an inferior quality.
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4.1.2 Mark-up Charge
NMS Purchase price Vs NMS issue price to Health Facility
The drug price charged to a health facility is determined by the rate of mark-up/handling fees charged by NMS on the purchase price. The statutory mark up as set in the NMS budget is approved by parliament at the beginning of each financial year which allows the entity to maintain a mark-up as shown in table 11 below:
Table 11: Showing statutory Mark-up for EMHS, ARVs and ACTs.
Drug Percentage Mark-up
EMHS 8%
ARVs and ACTs 7%
Source: NMS approved budgets
Through document review it was noted that the mark-up charged on the purchase price of the drugs to arrive at the issue price to the health facilities varied against the statutory 8% and 7% on EMHS and ARV drugs respectively14. In certain instances the mark-up charged on the drugs was below the stated statutory rate by as low as 75%. In other cases it was up to 44% higher than the statutory mark up. (Refer to Figure 4 and appendix VII )
Figure 4: Showing drugs above and below the statutory markup charge
As indicated in the figure above, there were variances over the three years in all sampled drugs between purchase and issue prices. These prices varied over and above the expected statutory charges. This implied additional charges on the cost price of the procured drugs to health facilities, for the rates that exceeded the statutory markup rate.
14 NMS budget statements 2015/16
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Conclusion
Whereas NMS purchased EMHS at lower prices relative to international market prices, anti-cancer drug prices were found to be on the higher side. Similarly ARVs were found to be higher than the donated drug prices. Further in comparison with market prices NMS prices for EMHS were found to be generally lower than those of comparable providers.
Except for ARVs and anti-cancer drugs, EMHS drug prices were found to be generally reasonable for the sampled drugs.
Recommendations
• The Ministry of Health should work closely with the local company to ensure that the objective of the MoU to provide low cost pharmaceutical products is achieved. This will require compliance by government to the terms of agreement that give exclusive rights to the manufacture for purchase ARVs and ACTs since it was envisaged that increased economies of scale would drive prices down.
• Procurement of anti-cancer drugs should be opened up to all NDA approved manufacturers/suppliers. Drugs on the NDA register should only be rejected if it can be demonstrated that they are of inferior quality. In addition, NMS should co-opt subject matter specialists (UCI and NDA representatives) on the evaluation committee for the procurement of anti-cancer medicines. The procurement of SRA approved drugs should be undertaken in consultation with NDA.
• NMS should apply the 8% and 7% statutory mark up for EMHS and ARVs respectively as provided for in the approved annual budgets and as required by the Entity’s Financial Reporting Framework.
• NMS should ensure that the survey reports and procedures are comprehensively reviewed to ensure accuracy.
4.2 PLANNING AND DELIVERY OF EMHS According to the National Medical Stores Customer Charter December 2012, under “Product and Services Standards” (d), management undertakes to deliver EMHS according to customer orders in line with individual facility procurement plans and prevailing Ministry of Health Guidelines.
Through document review, interviews and physical inspections, it was observed that health facilities (HC IV, District Hospital and Regional Referral Hospital) experienced discrepancies in the quantities delivered by NMS during the period under review as details in the sections below.
Drugs not delivereda) Planned, Ordered but not issued Out of the selected 72 health facilities, 68, 68, 38 health facilities did not receive EMHS
quantities as planned and ordered for in 2013/14; 2014/15 and 2015/16, respectively. (Refer to Table 12 below and Appendix VIII)
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Table 12: Showing planned, ordered and but not issued quantities over a period of time
Health Facility 2013/14 (Packs) 2014/15 (Pack) 2015/16 (Packs)
Planned Ordered Issued Planned Ordered Issued Planned Ordered Issued
RRH 24,308 24,308 0 307,925 282,067 0 2,112 1,754 0
GH 31,684 31,684 0 167,037 154,390 0 1,422 1,892 0
HC IV 54,328 54,328 0 21,819 14,925 0 7,020 6,160 0
Source: OAG Analysis of Planned_Ordered_Issued Data from NMS
The above table shows quantities of EMHS planned and ordered for by various levels of health care but not fulfilled by NMS over the years 2013/14, 2014/15, and 2015/16.
b) Planned, Ordered but delivered less Out of the selected 72 health facilities, 67 received EMHS quantities less than what had
been ordered for during the three year period under review. (Refer to Table 13 below and Appendix IX).
Table 13: Showing planned, ordered but issued less quantities over a period of time
Health Facility 2013/14 (Packs) 2014/15 (Packs) 2015/16 (Packs)
Planned Ordered Issued Planned Ordered Issued Planned Ordered Issued
RRH 1,654,578 1,654,578 853,795 1,309,892 1,124,156 1,053,812 1,165,949 1,205,751 886,131
GH 723,944 723,944 331,420 849,909 929,543 821,726 346,207 425,737 296,770
HC IV 426,133 426,133 155,436 641,804 739,939 644,316 516,470 615,850 407,867
Source: OAG Analysis of Planned_Ordered_Issued Data from NMS
From the review of documentation and analysis of data, it was established that the short deliveries were caused by NMS budget constraints caused by unfavorable exchange rate fluctuations which led to a reduction in the purchasing power of released funds over the years and differences in the prices agreed between NMS and the health units at the planning stage and the actual prices eventually charged on dispatch. These are illustrated in the Table 14 below.
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
26
Table 14: Showing reduction in purchasing power due to exchange rate losses over the years
Period FY Release from MoFPED (UGX)
Statutory Fee [%]
Medicines Budget after deduction of service fee (UGX)
BOU Official Mid-Rate (Average)
Equivalent in USD
Cumulative Decrease in USD Equivalent
FY 2013/2014 EMHS 119,337,586,943 8% 109,790,579,988
ARVs 100,000,000,000 7% 93,000,000,000
Sub Total 219,337,586,943 202,790,579,988 2,538.34 79,891,023.26
FY 2014/2015 EMHS 118,466,726,861 8% 108,989,388,712
ARVs 99,535,663,957 7% 92,568,167,480
Total 218,002,390,818 201,557,556,192 2,823.22 71,392,791.28 8,498,231.98
FY 2015/2016 EMHS 118,614,466,778 8% 109,125,309,436
ARVs 100,000,000,000 7% 93,000,000,000
Total 218,614,466,778 202,125,309,436 3,442.96 58,706,842.20 12,685,949.07
Cumulative drop in purchasing power
21,184,181.06
%age drop in purchasing power
18%
Source: IFMS Releases and BOU exchange rate.
As indicated in the table above the percentage drop in purchasing power over the 3 years under review was 18% which subsequently affects quantities expected by health facilities.Additionally, Table 15 below shows that in many cases the prices agreed during procurement planning differ from those of the contract.
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
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Tabl
e 15
: Com
pari
son
betw
een
the
cont
ract
pri
ces
and
the
NM
S pr
ocur
emen
t pla
n pr
ices
Dru
gSt
reng
thP
acka
ging
FY 2
013/
14FY
201
4/15
FY 2
015/
16
Pro
cure
men
t P
lan
Con
trac
t pr
ice
(B)
% B
elow
(B)
%Ab
ove
(B)
Pro
cure
men
t P
lan
(A)
Con
trac
t pr
ice
(B)
%B
elow
(B
)%
Abov
e(B
)
Pro
cure
men
t P
lan
Con
trac
t pr
ice
(B)
%B
elow
(B
)%
Abov
e (B
)(A
)(A
)
Arte
met
her
+ lu
men
fatr
ine
20m
g/12
0mg
30 ta
b-
144,
685
-14
7,09
0-
179,
378
Amox
icill
in25
0mg
1000
Cap
sule
35,6
5034
,039
535
,500
43,1
3922
39,6
0040
,000
1
Dia
zepa
m5m
g10
00 ta
b4,
750
5,20
09,
655
869,
000
9,65
57
Eryt
hrom
ycin
250m
g10
00 ta
b69
,800
63,9
668
70,6
0071
,145
170
,600
86,7
6323
Salb
utam
ol4m
g10
00 T
ab2,
800
3,14
812
3,15
03,
501
113,
550
5,78
463
Folic
aci
d5m
g10
00 ta
b1,
650
1,57
45
1,65
02,
300
391,
800
2,30
028
Ibup
rofe
n20
0mg
1000
tab
5,95
05,
950
10,9
2684
11,0
0010
,926
1
Mag
nesi
um
Tris
ilica
te
com
p25
0+12
0mg
1000
Via
l3,
150
6,16
896
3,20
07,
679
140
6,85
07,
679
12
Par
acet
amol
500m
g10
00 ta
b10
,300
9,87
44
10,5
0010
,982
511
,250
11,5
002
Clo
trim
azol
e10
0 m
g6
pess
ary
700
558
2065
062
14
650
689
6
Cip
roflo
xaci
ne50
0mg
100
Tabl
et6,
450
6,32
02
6,40
07,
030
106,
850
8,57
325
Ora
l R
ehyd
ratio
n sa
lts
1Ltr
253,
650
3,45
25
3,70
04,
200
143,
850
4,20
09
Vita
min
A20
0.00
I U10
00 C
apsu
le80
,850
83,7
654%
101,
500
142,
290
4099
,300
173,
525
75
Sour
ce: O
AG A
naly
sis
of p
rocu
rem
ent p
lans
and
con
trac
t doc
umen
ts o
f sel
ecte
d dr
ugs
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
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Consequently, the increment in the prices agreed at the planning stage translates into incremental costs that health facilities had to bear resulting into fewer quantities being delivered to health facilities. (Refer to Table 16 below)
Table 16: Extra cost incurred due to changes in procurement plan/order prices and issue prices to Health Facilities
2013/14 2014/15 2015/16
ITEM QTY (Packs)
SUM OF VALUE LOST (UGX)
QTY (Packs)
SUM OF VALUE LOST (UGX)
QTY (Packs)
SUM OF VALUE LOST (UGX)
Oral rehy dration salts for 1lt
4,113
(185,981) 3,014
(1,093,476)
1,869
(1,367,548)
Amoxicillin 250mg capsule
21,788
(2,783,037) 26,366
(128,379,730)
22,398
(158,409,026)
Ciprofloxacin 500mg tablet
24,115
(1,337,737) 26,825
(14,765,608)
22,064 (40,947,318)
Clotrimazole 100mg pessary
14,619
1,706,117 13,336
500,174
10,149
(1,490,658)
Erythromycin stearate 250mg tablet
3,557
(3,098,892) 3,194
52,125
1,062 (20,888,478)
Folic acid 5mg tablet 3,336
(148,912) 3,358
(1,058,710)
845
(3,336,590)
Ibuprofen 200mg tablet
2,420
(11,427,240) 6,820
(34,125,570)
1,655
(69,510)
Magnesium trisilicate comp 250+120mg tablet
4,043
(7,151,291) 3,164
(11,979,513)
617
(1,446,420)
Diazepam 5 mg tablet
602
(2,728,543) 612
(2,971,848)
371
(698,481)
Paracetamol 500mg tablet,
21,562
(5,381,485) 23,648
(26,136,138)
19,469 (30,566,330)
Salbutamol 4mg tablet
862
(335,194) 1,209
(440,894)
1,090
(2,681,598)
Vitamin a (retinol) 200.000 I u capsule
177
(3,324,786) 238
(875,727)
170 (13,777,322)
101,194 (36,196,981) 111,784 (221,274,915) 81,759 (275,679,279)
Source: OAG Analysis of NMS receipts and delivery data.
NMS also attributed the short deliveries to:• Change in treatment policy for example Amoxicillin 125mg dispersible tabs would not be
issued as the policy has changed to Amoxicillin 250mg dispersible tabs.• Change in item specifications for example sodium hypochlorite 6% 1Litre (at the time of
placing an order by the health facility) changing to sodium hypochlorite 6% 5Litre (at the time of issuing).
c) Unplanned, Not Ordered but Issued Out of the selected 72 health facilities, 68 and 65 health facilities received EMHS quantities
that had neither been planned nor ordered for in 2013/14 and 2014/15 respectively. (Refer to Table 17 below and Appendix X)
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Table 17: Showing unplanned, not ordered but issued quantities over a period of time
Health Facility 2013/14 (Packs) 2014/15 (Packs)
Planned Ordered Issued Planned Ordered Issued
RRH 0 0 360,559 0 0 776,460
GH 0 0 20,019 0 0 357,825
HC IV 0 0 16,222 0 0 820,376
Source: OAG Analysis of Planned_Ordered_Issued Data from NMS
The above table indicates that whereas in 2013/14 and 2014/15, the need for drugs was not expressed by the various levels of health care, NMS went ahead to supply RRH- 369,559 and 776,460; GH- 20,019 and 357,825 ; HC IVs- 16,222 and 820,376 packs, respectively. This was mainly attributed to the centrally pooled items which include ACTs, ARVs, TB commodities, vaccines and items delivered during emergencies and outbreaks.
d) Planned, Ordered but delivered in excess Out of the selected 72 health facilities, 66, 65 and 66 health facilities received EMHS
quantities in excess of what had been ordered for in 2013/14,2014/15 and 2015/16 respectively. (Refer to Table 18 below and Appendix XI)
Table 18: Showing planned, ordered but issued quantities in excess over a period of time
Health Facility 2013/14 (Packs) 2014/15 (Packs) 2015/16 (Packs)
Planned Ordered Issued Planned Ordered Issued Planned Ordered Issued
RRH 116,835 116,835 169,398 623,445 433,774 748,162 328,691 285,468 397,952
GH 63,103 63,103 88,777 430,005 435,629 585,776 326,331 306,996 375,126
HC IV 18,884 18,884 32,870 184,082 212,551 314,013 136,539 155,337 216,327
Totals 198,822 198,822 291,045 1,237,532 1,081,954 1,647,951 791,561 747,801 989,405
Source: OAG Analysis of Planned_Ordered_Issued Data from NMS
The table above indicates that there were health facilities that ordered for 198,822; 1,081,954; 747,801 packs of EMHS in 2013/14; 2014/15 and 2015/16, respectively but received more.NMS attributed this to push orders originated by MOH and third parties specifying quantities of drugs and medical supplies to be delivered to each specified district and health unit.
e) Planned, not ordered but deliveredOut of the selected 72 health facilities, 35 and 24 health facilities received EMHS quantities that had neither been planned nor ordered for in 2014/15 and 2015/16, respectively. (Refer to Table 19 below and Appendix XII)
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
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Table 19: Showing planned, not ordered but issued quantities over a period of time
Health Facility
2014/15 (Packs) 2015/16 (Packs)
Planned Ordered Issued Planned Ordered Issued
RRH 14,648 0 12,846 3,996 0 54,502
GH 3,672 0 8,623 4,271 0 1,659
HC IV 4,506 0 3,977 3,876 0 990
Source: OAG Analysis of Planned_Ordered_Issued Data from NMS
The other cause of the above discrepancies in quantities delivered was the preparation of procurement plans based on monthly consumption and the available budget without necessarily considering the disease burden of the treatment population.
ConclusionOverall, health facilities experienced discrepancies in delivered quantities during the period under review.
Recommendation• NMS should ensure that the prices provided to health facilities reflect the running
contract prices.• NMS should engage MoFPED and MoH to agree on a framework for bridging the
financing gaps caused by volatility in exchange rates.• Changes in treatment policy and item specification should be properly planned and
communicated in order not to impact on the procurement and supply chain. • MoH should ensure that arrangements for supplies of emergency drugs are done in full
consultation with NMS and the beneficiary health facilities to enable proper planning of procurement and utilization.
• NMS should ensure that procurement planning is undertaken based on the disease burden other than the average monthly consumption.
4.3 TIMELINESS OF EMHS DELIVERIES According to the National Medical Stores Customer Charter December 2012, under Part (b) and (c) of “Product and Services Standards” NMS undertakes to deliver essential medicines and health supplies to the doorstep of all customers, and to deliver essential medicines and health supplies according to the published delivery schedule (Appendix IV) by level of care. NMS adherence to set delivery dates
Through document review and interviews of the delivery dates for the selected health facilities audit established that whereas efforts were made to deliver EMHS in time, cases of delays were noted as indicated in the Table 20 below.
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
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Table 20: Showing average LATE and EARLY deliveries
Years Late (days) Early (days)
FY 13/14 9 7.4
FY 14/15 10 9.6
FY 15/16 14 8.2
Source: OAG Analysis of delivery dates to health facilities
The table above indicates the number of days NMS delivered as per the scheduled deadlines and those where it delivered late. Figure 5 below shows a graphical presentation of the above data.
Figure 5: Showing Average Late and Early Deliveries made by NMS
Delayed deliveries were caused by:• Late submission of orders by Health facilities as indicated in the table 21 below:
Table 21: Showing average LATE and EARLY orders
FY 13/14 FY 14/15 FY 15/16
Late 6 12 25
Early 5 5 37
Source: OAG Analysis of order dates to health facilities
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
32
Figure 6: Showing Average Late and Prompt Orders made by NMS
• Additionally, audit attributed the delays in deliveries to delayed response to customer complaints within the stipulated period of seven (7) working days and close out period of 14 working days. Out of 72 sampled health facilities, 26,13 and 12 health facilities (Refer Appendix XIII) raised discrepancies in delivery over the three year period that is 2013/14;2014/15 and 2015/16. However by the end of the audit (December 2015), none has been responded to as per NMS commitment on complaint management.
Consequently, there was a stock out of essential medicines and health supplies at the facilities averaging (9-15) days for the selected health facilities thereby hampering service delivery.ConclusionWhereas efforts were made by NMS to deliver EMHS in a timely fashion, delays were noted during the period under review.
RecommendationsNMS should:• Automate the processes of planning, ordering, receipting, storage, distribution and
delivery of orders. • Endeavor to promptly resolve customer complaints in a timely fashion.
OVERALL AUDIT CONCLUSION
Whereas NMS purchased EMHS at lower prices relative to international market prices, anti-cancer drug prices were found to be on the higher side. Similarly, ARVs prices were found to be higher than the donated drug prices. Further in comparison with market prices NMS prices for EMHS were found to be generally lower than those of comparable providers. However, the excessive charge for the handling fees impacted on the prices charged to health facilities.
Therefore, except for ARVs and anti-cancer drugs, EMHS drug prices were found to be generally reasonable for the sampled drugs.Overall, health facilities experienced discrepancies in delivered quantities during the period under review.Whereas efforts were made by NMS to deliver EMHS in a timely fashion, cases of delays were noted.
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
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GLOSSARY OF TERMS
Mark up: A mark-up represents the additional charges and costs that are applied to the price of a commodity in order to cover overhead costs, distribution charges, and profit15.
Related Agencies: This refers to the MoH, which is the Government Ministry responsible and answerable for the overall health policy, Medicines, medication lf the people in Uganda and has power to bind the Ministry of Local Government, Mulago Hospital, Regional Hospitals, District Hospitals, The Directorate of Medical Services of the UPDF, JCRC, NMS, TASO and any GOU supported entities or Projects for their requirements or consumption of ARVs and Anti-Malarial ACTs.
Reference Price/ Median International Price: The practice of using the price of a pharmaceutical product (generally ex-manufacturer price, or other common point within the distribution chain) in one or several countries to derive a benchmark or reference price for the purposes of setting or negotiating the price of the product in a given country.
Reasonable price: Lowest possible price at which the drug can be delivered to the health facility.
Essential Medicines and Health Supplies: Medicines, medical devices, health supplies, laboratory supplies and consumables, medical and laboratory equipment.
15 WHO guidelines on pharmaceutical, pricing, 2015, page 6
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
34
APPENDICES
APPENDIX I: DOCUMENTS REVIEWEDName of the Document Information Obtained
National Medical Stores ACT 1993
To understand the establishment of National Medical Stores and to provide for its composition, powers, object and functions, administration and finances and other matters connected therewith.
Health Sector Monitoring Reports
To assess the performance of selected programs/projects within the health sector, detailing their financial and physical progress, implementation challenges and proposed actions for improvement.
National Pharmaceutical Sector Plan 14/15To understand issues such as the medicines supply chain, financing, pricing and appropriate use of medicine.
Stores and Operations Manual Version 1.2
To check whether NMS has ensured that the medicines and supplies of the required quality are correctly acquired, stored, and distributed to health units under the NMS mandate on time and at the least cost.
National Drug Policy 1993
To understand the continuing development of the pharmaceutical sector in Uganda and the substantive improvements in the national pharmaceutical service provision.
Aggregated Procurement Plans
National SPARS Performance Report 2015
To understand the management tool that provides information on the medicines management situation in the country as well as the results from 109 districts implementing the supervision, performance assessment and recognition strategy (SPARS).
Sales and Marketing ManualTo understand the NMS’ equitable framework for the treatment of all customers in line with the NMS vision.
Annual Pharmaceutical Sector Performance Report 2013/14
To understand the achievement of four out of thirty two key pharmaceutical indicators
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
35
APPENDIX II: LIST OF PEOPLE INTERVIEWED
Position Reason for interview
Commissioner Pharmaceutical-NMS
To understand his role in the drugs supply chain. Obtain the relationship they have with NMS.
Inspector of drugs-NDATo understand what role they play in the regulation of drugs coming into the country.
Head of Procurement-NMSTo understand what role the procurement department plays in the drugs supply chain.
Head Stores and Operations To understand what role he plays in the drugs supply chain.
Head of Quality Assurance To understand the role she plays in the drugs supply chain
Head of sales and marketingTo understand the role the sales and marketing department plays in the drug supply chain.
Stores assistant Nakasongola HCIV
To understand how the HF places orders to NMS and how expired drugs are handled at the HF
Luwero District Health OfficerTo understand the general operations of NMS in Luwero district, and how HFs interact with NMS.
Pharmacist, Mukono HCIVTo understand how the HF places orders to NMS and how expired drugs are handled at the HF.
Assistant in charge, Luwero HCIVTo understand how the HF places orders to NMS and how expired drugs are handled at the HF
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
36
APPENDIX III: ORGANISATIONAL STRUCTURE
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
37
AP
PEN
DIX
IV: S
ET O
RD
ER A
ND
DEL
IVER
Y TI
MEL
INES
YRS
ZON
E 1
ZON
E 2
ZON
E 3
ZON
E 4
ZON
E 5
Ord
er
dead
line
deliv
ery
dead
line
Ord
er
dead
line
deliv
ery
dead
line
Ord
er
dead
line
deliv
ery
dead
line
Ord
er
dead
line
deliv
ery
dead
line
Ord
er
dead
line
deliv
ery
dead
line
2013
/14
04-0
6-13
18-0
7-13
20-0
6-13
01-0
8-13
15-0
7-13
13-0
8-13
25-0
7-13
23-0
8-13
06-0
8-13
27-0
8-13
08-0
8-13
12-0
9-13
26-0
8-13
26-0
9-13
09-0
9-13
08-1
0-13
19-0
9-13
21-1
0-13
01-1
0-13
23-1
0-13
03-1
0-13
08-1
1-13
22-1
0-13
22-1
1-13
05-1
1-13
04-1
2-13
15-1
1-13
02-0
1-13
27-1
1-13
06-0
1-14
28-1
1-13
22-0
1-14
03-0
1-14
05-0
2-14
17-0
1-14
17-0
2-14
29-0
1-14
27-0
2-14
10-0
2-14
03-0
3-14
12-0
2-14
19-0
3-14
28-0
2-14
02-0
4-14
14-0
3-14
14-0
4-14
26-0
5-14
28-0
4-14
07-0
4-14
30-0
4-14
09-0
4-14
19-0
5-14
29-0
4-14
02-0
6-14
14-0
5-14
16-0
6-14
26-0
5-14
26-0
6-14
06-0
6-14
30-0
6-14
2014
/15
02-0
6-14
30-0
7-14
20-0
6-14
13-0
8-14
11-0
7-14
25-0
8-14
23-0
7-14
04-0
9-14
04-0
8-14
08-0
9-14
06-0
8-14
24-0
9-14
22-0
8-14
18-1
0-14
05-0
9-14
20-1
0-14
17-0
9-14
31-1
0-14
29-0
9-14
04-1
1-14
01-1
0-14
16-1
1-14
20-1
0-14
30-1
1-14
03-1
1-14
12-1
2-14
13-1
1-14
22-1
2-14
25-1
1-14
24-1
2-14
26-1
1-14
28-0
1-15
24-1
2-14
12-0
2-15
16-0
1-15
24-0
2-15
29-0
1-15
06-0
3-15
10-0
2-15
10-0
3-15
12-0
2-15
23-0
3-15
02-0
3-15
06-0
4-15
16-0
3-15
18-0
4-15
26-0
3-15
02-0
5-15
07-0
4-15
04-0
5-15
09-0
4-15
19-0
5-15
29-0
4-15
02-0
6-15
14-0
5-15
16-0
6-15
26-0
5-15
26-0
6-15
08-0
6-15
30-0
6-15
2015
/16
17-0
6-15
05-0
8-15
06-0
7-15
14-0
8-15
28-0
7-15
24-0
8-15
05-0
8-15
02-0
9-15
14-0
8-15
07-0
9-15
19-0
8-15
28-0
9-15
09-0
9-15
07-1
0-15
18-0
9-15
16-1
0-15
28-0
9-15
27-1
0-15
07-1
0-15
30-1
0-15
13-1
0-15
20-1
1-15
03-1
1-15
01-1
2-15
12-1
1-15
09-1
2-15
15-1
1-15
15-1
2-15
18-1
1-15
18-1
2-15
04-1
2-15
05-0
2-16
18-0
1-16
16-0
2-16
28-0
1-16
24-0
2-16
05-0
2-16
04-0
3-16
16-0
2-16
10-0
3-16
19-0
2-16
31-0
3-16
14-0
3-16
11-0
4-16
23-0
3-16
21-0
4-16
31-0
3-16
02-0
5-16
11-0
4-16
05-0
5-16
14-0
4-16
26-0
5-16
09-0
5-16
07-0
6-16
18-0
5-16
16-0
6-16
26-0
5-16
27-0
6-16
07-0
6-16
30-0
6-16
Sour
ce: O
AG E
xtra
ct o
f del
iver
y sc
hedu
le
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
38
AP
PEN
DIX
V: C
ON
TRA
CT
PR
ICES
AN
D P
UR
CH
ASE
PR
ICES
FO
R A
NTI
-CA
NC
ER D
RU
GS
S/n
Dru
gSu
pplie
rP
rocu
rem
ent r
efer
ence
Con
trac
t si
gn d
ate
Con
trac
t pr
ice
(usd
) (a)
2015
Pur
chas
e pr
ice
(B)
% A
bove
(a
)%
Bel
ow
(a)
1P
aclit
axel
100
mg
vial
Kim
sy m
eds
ltd
Nm
s/su
pls/
14-1
5/00
036
8-Ja
n-15
41
41.
00
0
2O
xalip
latin
inj 5
mg/
ml 1
0ml v
ial
Kim
sy m
eds
ltd
Nm
s/su
pls/
14-1
5/00
036
8-Ja
n-15
37
37.
00
0
3C
ispl
atin
inje
ctio
n bp
50m
g/10
0ml
Kim
sy m
eds
ltd
Nm
s/su
pls/
14-1
5/00
036
8-Ja
n-15
28.4
5
28.
45
0
4D
oxor
ubic
in h
ydro
chlo
ride
50m
g vi
al K
imsy
med
s lt
d N
ms/
supl
s/14
-15/
0003
68-
Jan-
1522
1
6.43
25
5D
ocet
axel
40m
g/m
l 2m
l via
l K
imsy
med
s lt
d N
ms/
supl
s/14
-15/
0003
68-
Jan-
1565
6
5.00
0
6C
arbo
plat
in 1
0mg/
ml,
45 m
l via
l K
imsy
med
s lt
d N
ms/
supl
s/14
-15/
0003
68-
Jan-
1568
.25
6
8.25
0
7L-
aspa
ragi
nase
10,
000i
u vi
al K
imsy
med
s lt
d N
ms/
supl
s/14
-15/
0003
68-
Jan-
1587
8
7.00
0
8D
acar
bazi
ne 2
00m
g vi
al K
imsy
med
s lt
d N
ms/
supl
s/14
-15/
0003
68-
Jan-
1512
.7
12.
70
0
9Fi
lgra
stim
300
mcg
/ml 1
ml v
ial
Nor
vik
ent l
td
Nm
s/su
pls/
14-1
5/00
070
22-J
un-1
536
5
9.88
66
10G
emci
tabi
ne h
cl 1
g in
25m
l via
l K
imsy
med
s lt
d N
ms/
supl
s/14
-15/
0003
68-
Jan-
1545
47.2
4 5
11C
apec
itabi
ne 5
00m
g ta
blet
s N
orvi
k en
t ltd
N
ms/
supl
s/14
-15/
0007
024
-Apr
-15
2747
0.36
16
42
Sour
ce: O
AG A
naly
sis
of c
ontr
act a
nd p
urch
ase
pric
e
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
39
AP
PEN
DIX
VI:
CO
MP
AR
ISO
N B
ETW
EEN
SU
RVE
Y P
RIC
ES A
ND
PU
BLI
SHED
PR
ICES
SNM
edic
al S
uppl
ySt
reng
thpa
ckag
ing
NM
S Su
rvey
Pri
ces
Com
pari
son
(A)
Audi
t Est
ablis
hed
Pri
ces
com
pari
son
(B)
The
perc
enta
ge V
aria
nce
(B-A
)/B
NM
S P
rice
sJM
SM
SDM
SH/W
HO
pr
ices
(exc
hang
e ra
te a
v. F
Y201
4)
NM
S
Con
trac
t P
rice
sJM
SM
SDM
SH/W
HO
pr
ices
(exc
hang
e ra
te a
v. F
Y201
4)
NM
S P
rice
s(A)
JMS
MSD
MSH
/WH
O
pric
es(e
xcha
nge
rate
av.
FY2
014)
(B
)
Abov
eB
elow
Abov
eB
elow
1Ar
tem
ethe
r+
lum
enfa
trin
e20
mg/
120m
g30
tab
142,
291
140,
400
21
1,02
2
2Am
oxic
illin
250m
g10
00
Cap
sule
42
,320
64,4
5047
,263
68,7
9146
,502
64,4
5047
,263
68,4
689
00
3D
iaze
pam
5m
g10
00 ta
b11
,901
50,4
0015
,402
78,0
9611
,933
50,4
0015
,402
31,9
080
00
145
4Sa
lbut
amol
4mg
1000
tab
5,75
130
,990
8,45
622
,598
5,95
430
,990
8,45
612
,630
30
079
5Fo
lic a
cid
5mg
1000
Tab
2,26
729
,070
7,70
111
,632
2,43
729
,070
7,70
111
,965
70
03
6Ib
upro
fen
200m
g10
00 ta
b13
,483
21,0
50
64,1
3810
,992
21,0
50
25,5
9223
0
151
7M
agne
sium
Tr
isili
cate
com
p 25
0+12
0mg
1000
tab
9,45
0 0
17
,614
9,02
816
,487
7,70
114
,957
5
18
8Er
ythr
omyc
in25
0mg
1000
Via
l83
,583
102,
820
14
2,23
390
,121
102,
820
94,5
2614
5,57
87
0
2
9P
arac
etam
ol50
0mg
1000
tab
11,5
0017
,006
11,4
7622
,598
12,4
2017
,006
11,4
7616
,619
70
036
10C
lotr
imaz
ole
100
mg
6 pe
ssar
y76
61,
071
1,
949
745
1,07
11,
510
2,32
73
0
16
11C
ipro
floxa
cine
500m
g10
0 Ta
blet
8,66
59,
585
9,66
412
,927
8,89
69,
585
9,66
415
,954
30
019
12O
ral R
ehyd
ratio
n sa
lts
1Ltr
254,
200
5,91
58,
418
4,15
44,
533
5,91
533
,673
9,97
17
075
58
13Vi
tam
in A
20
0.00
I U10
00
Cap
sule
184,
929
133,
490
18
5,43
518
4,98
744
4,96
720
0,83
020
7,73
10
70
11
Sour
ce: O
AG A
naly
sis
of S
urve
y R
epor
ts a
nd d
iffer
ent p
rice
cat
alog
ues
Assu
me:
1 T
Z= 1
.51s
hs; 1
$=
3,32
3.7s
hs
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
40
AP
PEN
DIX
VII:
SH
OW
ING
AD
DIT
ION
AL
MA
RK
-UP
CH
AR
GES
AN
D E
XTR
A C
OST
INCU
RR
ED B
Y H
EALT
H F
ACI
LITI
ES
BET
WEE
N P
LAN
NIN
G/O
RD
ERIN
G A
ND
ISSU
E.
DR
UG
2013
/14
(Avg
Pri
ces)
2014
/15
(Avg
Pri
ces)
2
015/
16 (A
vg P
rice
s)
ARVs
and
AC
Ts P
urch
ase(
B)
Issu
e (C
) Ex
act
Abov
e m
ark
up
Bel
ow
mar
k up
Pur
chas
e Is
sue
Exac
tAb
ove
mar
k up
Bel
ow
mar
k up
Pur
chas
e Is
sue
Exac
tAb
ove
mar
k up
Bel
ow
mar
k up
Arte
met
her
20m
g+lu
mef
antr
ine
120m
g(st
rip
of 2
4)13
3,64
614
9,52
1
5%
147,
090
147,
983
6%17
9,37
817
7,38
0
8%
Efav
iren
z 6
00m
g ta
b17
,186
16,5
66
11
%16
,939
14,5
74
21
%20
,494
20,8
40
5%
Efav
iren
z 20
0 m
g ca
p
-
-
-
-
-
-
Lam
ivud
ine1
50m
g +
zido
vudi
ne 3
00 m
g ta
b,24
,039
33,8
63
34%
18
,998
24,8
12
24%
32
,708
-
7%
Lam
ivud
ine1
50m
g+zi
dovu
dine
300m
g+ne
vira
pine
200m
g t
35,1
8838
,754
3%
24
,862
37,5
44
44%
40
,937
44,1
52
1%
Nev
irap
ine
200m
g ta
b
-
10,8
78
-
-
11,2
93
-
Teno
fovi
r/la
miv
udin
e 30
0mg/
300m
g ta
blet
s21
,775
24,7
22
7%
15,5
2921
,825
34
%
26,6
0526
,077
9%
Teno
fovi
r/la
miv
udin
e/ef
avir
enz
300m
g/30
0mg/
600m
g
-
-
37,3
05
-
45
,494
40,9
23
17
%
Emhs
Amox
icill
in 2
50m
g ca
psul
e34
,717
35,6
16
5%
40,0
0040
,488
7%31
,338
46,3
32
40%
Dia
zepa
m 5
mg
tabl
et8,
431
8,86
4
3%
9,65
59,
945
5%11
,775
12,1
72
5%
Salb
utam
ol 4
mg
tabl
et3,
148
3,16
7
7%
3,88
33,
641
14%
5,78
46,
021
4%
Folic
aci
d 5m
g ta
blet
1,57
41,
693
0%
1,
750
1,98
7
6%
11,9
006,
007
58%
Ibup
rofe
n 20
0mg
tabl
et9,
823
10,6
65
1%
10,9
2610
,951
8%13
,324
10,9
92
26
%
Mag
nesi
um tr
isili
cate
com
p 25
0+12
0mg
tabl
et6,
168
6,86
0
4,
726
Eryt
hrom
ycin
ste
arat
e 25
0mg
tabl
et64
,431
70,5
50
1%
-
70,5
83
86,7
6390
,149
4%
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
41
Par
acet
amol
500
mg
tabl
et,
9,87
410
,538
1%10
,982
11,6
64
2%
11,5
0012
,420
0%
Clo
trim
azol
e 10
0mg
pess
ary
532
587
2%
62
161
3
9%
748
767
5%
Cip
roflo
xaci
n 50
0mg
tabl
et6,
082
6,96
3
8%8,
565
Ora
l reh
ydra
tion
salt
s fo
r 1l
t3,
458
3,67
3
2%
3,84
64,
072
2%4,
200
4,53
30%
Vita
min
a (r
etin
ol) 2
00.0
00 I
u ca
psul
e
-
101,
636
163,
609
Can
cer
Pac
litax
el 1
00m
g vi
al15
6,50
012
6,91
2
27
%11
2,69
412
0,30
0
1%
141,
161
142,
637
7%
Oxa
lipla
tin in
j 5m
g/m
l 10m
l via
l10
1,96
511
1,64
6
1%
4011
3,57
1
127,
389
133,
813
3%
Cis
plat
in in
ject
ion
bp 5
0mg/
100m
l85
,872
89,5
14
4%
76,1
1477
,030
7%97
,952
105,
011
1%
Dox
orub
icin
hyd
roch
lori
de 5
0mg
vial
47,5
0051
,272
0%
50
,959
53,0
22
4%
56,5
6853
,987
13%
Doc
etax
el 4
0mg/
ml 2
ml v
ial
248,
333
252,
279
6%27
3,00
029
4,84
00%
223,
792
261,
051
9%
Car
bopl
atin
10m
g/m
l, 45
ml v
ial
214,
864
230,
673
1%23
6,95
877
,030
75%
234,
982
255,
829
1%
L-as
para
gina
se 1
0,00
0iu
vial
123,
494
132,
554
1%24
5,62
018
6,22
0
32
%29
9,53
732
2,28
90%
Dac
arba
zine
200
mg
vial
22,4
8424
,215
0%
35
,855
33,2
91
15
%43
,726
46,3
95
2%
Ritu
xim
ab 5
00m
g 50
ml v
ials
-
5,
291,
800
5,71
5,14
40%
0%
6,50
1,33
67,
184,
723
3%
Filg
rast
im 3
00m
cg/m
l 1m
l via
l31
0,40
033
6,26
70%
387,
952
351,
983
17%
206,
174
210,
754
6%
Cyc
loph
osph
amid
e 1g
m v
ial
-
73
,440
54
,539
59,6
09
1%
50,9
9055
,676
1%
Cal
cium
folin
ate
50m
g/5m
l via
l23
,036
24,2
45
3%
23,0
3624
,859
0%80
,737
88,7
28
2%
Gem
cita
bine
hcl
1g
in 2
5ml v
ial
137,
743
160,
414
8%
14
7,37
515
0,62
3
6%
162,
633
166,
880
5%
Cap
ecita
bine
500
mg
tabl
ets
99,2
7410
7,84
7
1%
915,
598
1,08
4,90
2
10%
1,
349,
521
1,06
0,57
5
29
%
Dau
noru
bici
n hc
l 20m
g vi
al10
7,30
011
1,07
7
4%
95,1
1496
,866
6%11
5,99
312
4,59
3
1%
4
1013
26
21
3
720
Sour
ce: O
AG A
naly
sis
of H
F pr
ocur
emen
t pla
ns, N
MS
purc
hase
pri
ces
and
Issu
ed p
rice
s
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
42
APPENDIX VIII: LIST OF HEALTH FACILITIES THAT PLANNED, ORDERED BUT DID NOT RECEIVE
Health Facility 2013/14 2014/15 2015/16
RRH Fort Portal HospitalGulu HospitalLira HospitalMbarara University HospitalMubende HospitalSoroti Hospital
Fort Portal HospitalGulu HospitalLira HospitalMbarara University HospitalMubende HospitalSoroti Hospital
Gulu HospitalLira HospitalMbarara University HospitalMubende HospitalSoroti Hospital
GH Bududa HospitalBugiri HospitalEntebbe HospitalIganga HospitalKamuli HospitalKayunga HospitalKiryandongo HospitalKisoro HospitalMasindi HospitalNakaseke HospitalTororo Hospital
Bududa HospitalBugiri HospitalEntebbe HospitalIganga HospitalKamuli HospitalKayunga HospitalKiryandongo HospitalKisoro HospitalMasindi HospitalNakaseke HospitalTororo Hospital
Kisoro HospitalMasindi HospitalNakaseke HospitalTororo Hospital
HC IV Aduku HCIVAlebtong HCIVAmach HCIVAtiak HCIVBugangari HCIVBugembe HCIVBugobero HCIVBukomero HCIVBukulula HCIVBumanya HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBusia HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKabalye Pts Police HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKasangati HCIVKawempe HCIVKidera HCIVKigorobya HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKitwe HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVLalogi HCIVLuweero HCIVMadi Opei HCIVMaziba HCIVMidigo HCIV
Aduku HCIVAlebtong HCIVAmach HCIVAtiak HCIVBugangari HCIVBugembe HCIVBugobero HCIVBukomero HCIVBukulula HCIVBumanya HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBusia HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKabalye Pts Police HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKasangati HCIVKawempe HCIVKidera HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKitwe HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVLalogi HCIVLuweero HCIVMadi Opei HCIVMaziba HCIVMidigo HCIVMungula HCIV
Aduku HCIVAlebtong HCIVBugembe HCIVBugobero HCIVBukulula HCIVBusesa HCIVBushenyi HCIVButenga HCIVBuwambo HCIVKabalye Pts Police HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKigorobya HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVMaziba HCIVMidigo HCIVMungula HCIVNtara HCIVOli HCIVRubuguri HCIVSsembabule HCIVTiriri HCIV
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
43
HC IV Mungula HCIVMuyembe HCIVNagongera HCIVNamwendwa HCIVNankoma HCIVNdejje HCIVOli HCIVPadibe HCIVRukungiri HCIVSsembabule HCIVTiriri HCIVTokora HCIV
Muyembe HCIVNagongera HCIVNamwendwa HCIVNankoma HCIVNdejje HCIVNtara HCIVOli HCIVPadibe HCIVRubuguri HCIVRukunyu HCIVSsembabule HCIVTiriri HCIVTokora HCIV
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
44
APPENDIX IX: SHOWING UNPLANNED, NOT ORDERED BUT ISSUEDHealth Facility 2013/14 2014/15 2015/16
RRH Fort Portal HospitalGulu HospitalLira Hospital
Mbarara University HospitalMubende HospitalSoroti Hospital
Fort Portal HospitalGulu HospitalLira HospitalMbarara University HospitalMubende HospitalSoroti Hospital
Fort Portal HospitalGulu HospitalLira HospitalMbarara University HospitalMubende HospitalSoroti Hospital
GH Bududa HospitalBugiri HospitalEntebbe HospitalIganga HospitalKamuli HospitalKayunga HospitalKiryandongo HospitalKisoro HospitalMasindi HospitalNakaseke HospitalTororo Hospital
Bududa HospitalBugiri HospitalEntebbe HospitalIganga HospitalKamuli HospitalKayunga HospitalKiryandongo HospitalKisoro HospitalMasindi HospitalNakaseke HospitalTororo Hospital
Bududa HospitalBugiri HospitalEntebbe HospitalIganga HospitalKamuli HospitalKayunga HospitalKiryandongo HospitalKisoro HospitalMasindi HospitalNakaseke HospitalTororo Hospital
HC IV Aduku HCIVAlebtong HCIVAmach HCIVAtiak HCIVBugangari HCIVBugembe HCIVBugobero HCIVBukomero HCIVBukulula HCIVBumanya HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBusia HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKabalye Pts Police HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKasangati HCIVKawempe HCIVKidera HCIVKigorobya HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKitwe HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVLalogi HCIVLuweero HCIVMadi Opei HCIVMaziba HCIVMidigo HCIV
Aduku HCIVAlebtong HCIVAmach HCIVAtiak HCIVBugangari HCIVBugembe HCIVBugobero HCIVBukomero HCIVBukulula HCIVBumanya HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBusia HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKabalye Pts Police HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKasangati HCIVKawempe HCIVKidera HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKitwe HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVLalogi HCIVLuweero HCIVMadi Opei HCIVMaziba HCIVMidigo HCIVMungula HCIV
Aduku HCIVAlebtong HCIVAmach HCIVAtiak HCIVBugangari HCIVBugembe HCIVBugobero HCIVBukomero HCIVBukulula HCIVBumanya HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBusia HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKabalye Pts Police HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKasangati HCIVKawempe HCIVKidera HCIVKigorobya HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKitwe HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVLalogi HCIVLuweero HCIVMadi Opei HCIVMaziba HCIVMidigo HCIV
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
45
HC IV Mungula HCIVMuyembe HCIVNagongera HCIVNamwendwa HCIVNankoma HCIVNdejje HCIVOli HCIVPadibe HCIVRukungiri HCIVSsembabule HCIVTiriri HCIVTokora HCIV
Muyembe HCIVNagongera HCIVNamwendwa HCIVNankoma HCIVNdejje HCIVNtara HCIVOli HCIVPadibe HCIVRubuguri HCIVRukunyu HCIVSsembabule HCIVTiriri HCIVTokora HCIV
Mungula HCIVMuyembe HCIVNdejje HCIVNtara HCIVOli HCIVPadibe HCIVRubuguri HCIVRukungiri HCIVRukunyu HCIVSsembabule HCIVTiriri HCIVTokora HCIV
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
46
APPENDIX X: SHOWING HEALHT FACILITIES THAT WERE ISSUED DRUGS THAT THEY HAD NEITHER PLANNED NOR ORDERED FOR
Health Facility 2013/14 2014/15
RRH Fort Portal HospitalGulu HospitalLira Hospital
Mbarara University HospitalMubende HospitalSoroti Hospital
Fort Portal HospitalGulu HospitalLira HospitalMbarara University HospitalMubende Hospital
GH Bududa HospitalBugiri HospitalEntebbe HospitalIganga HospitalKamuli HospitalKayunga HospitalKiryandongo HospitalKisoro HospitalMasindi HospitalNakaseke HospitalTororo Hospital
Bududa HospitalBugiri HospitalIganga HospitalKamuli HospitalKayunga HospitalKiryandongo HospitalKisoro HospitalMasindi HospitalTororo Hospital
Aduku HCIVAlebtong HCIVAmach HCIVAtiak HCIVBugangari HCIVBugembe HCIVBugobero HCIVBukomero HCIVBukulula HCIVBumanya HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBusia HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKabalye Pts Police HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKasangati HCIVKawempe HCIVKidera HCIVKigorobya HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKitwe HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVLalogi HCIVLuweero HCIVMadi Opei HCIVMaziba HCIVMidigo HCIV
Aduku HCIVAlebtong HCIVAmach HCIVAtiak HCIVBugangari HCIVBugembe HCIVBugobero HCIVBukomero HCIVBukulula HCIVBumanya HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBusia HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKabalye Pts Police HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKasangati HCIVKawempe HCIVKidera HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKitwe HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVLalogi HCIVLuweero HCIVMadi Opei HCIVMaziba HCIVMidigo HCIVMungula HCIV
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
47
HC IV Mungula HCIVMuyembe HCIVNagongera HCIVNamwendwa HCIVNankoma HCIVNdejje HCIVOli HCIVPadibe HCIVRukungiri HCIVSsembabule HCIVTiriri HCIVTokora HCIV
Muyembe HCIVNagongera HCIVNamwendwa HCIVNankoma HCIVNdejje HCIVNtara HCIVOli HCIVPadibe HCIVRubuguri HCIVRukunyu HCIVSsembabule HCIVTiriri HCIVTokora HCIV
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
48
APPENDIX XI: SHOWING HEALTH FACILITIES THAT RECEIVED IN EXCESS OF THEIR ORDERS.
Health Facility
2013/14 2014/15 2015/16
RRH Fort Portal HospitalGulu HospitalLira Hospital
Mbarara University HospitalMubende HospitalSoroti Hospital
Fort Portal HospitalGulu HospitalLira HospitalMbarara University HospitalMubende Hospital
Fort Portal HospitalGulu HospitalLira HospitalMbarara University HospitalMubende HospitalSoroti Hospital
GH Bududa HospitalBugiri HospitalEntebbe HospitalIganga HospitalKamuli HospitalKayunga HospitalKiryandongo HospitalKisoro HospitalMasindi HospitalNakaseke HospitalTororo Hospital
Bududa HospitalBugiri HospitalIganga HospitalKamuli HospitalKayunga HospitalKiryandongo HospitalKisoro HospitalMasindi HospitalTororo Hospital
Bududa HospitalBugiri HospitalEntebbe HospitalIganga HospitalKamuli HospitalKayunga HospitalKiryandongo HospitalKisoro HospitalMasindi HospitalNakaseke HospitalTororo Hospital
HC IV Aduku HCIVAlebtong HCIVAmach HCIVAtiak HCIVBugangari HCIVBugembe HCIVBugobero HCIVBukomero HCIVBukulula HCIVBumanya HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBusia HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKasangati HCIVKawempe HCIVKidera HCIVKigorobya HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKitwe HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVLalogi HCIVLuweero HCIVMadi Opei HCIVMaziba HCIVMidigo HCIV
Aduku HCIVAlebtong HCIVAmach HCIVAtiak HCIVBugangari HCIVBugembe HCIVBugobero HCIVBukomero HCIVBukulula HCIVBumanya HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBusia HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKabalye Pts Police HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKasangati HCIVKawempe HCIVKidera HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKitwe HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVLalogi HCIVLuweero HCIVMadi Opei HCIVMaziba HCIVMidigo HCIV
Aduku HCIVAlebtong HCIVAmach HCIVAtiak HCIVBugangari HCIVBugembe HCIVBugobero HCIVBukomero HCIVBukulula HCIVBumanya HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBusia HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKabalye Pts Police HCIVKakuuto HCIVKarenga HCIVKarugutu HCIVKasangati HCIVKawempe HCIVKidera HCIVKigorobya HCIVKihihi HCIVKikuube HCIVKinoni [Mbarara] HCIVKiruhura HCIVKitwe HCIVKumi HCIVKyabugimbi HCIVKyegegwa HCIVLalogi HCIVLuweero HCIVMadi Opei HCIVMaziba HCIV
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
49
HC IV Mungula HCIVMuyembe HCIVNagongera HCIVNamwendwa HCIVNankoma HCIVNdejje HCIVOli HCIVPadibe HCIVRukungiri HCIVSsembabule HCIVTiriri HCIVTokora HCIV
Mungula HCIVMuyembe HCIVNagongera HCIVNamwendwa HCIVNankoma HCIVNdejje HCIVNtara HCIVOli HCIVPadibe HCIVRubuguri HCIVRukunyu HCIVSsembabule HCIVTiriri HCIVTokora HCIV
Midigo HCIVMungula HCIVMuyembe HCIVNdejje HCIVNtara HCIVOli HCIVPadibe HCIVRukungiri HCIVRukunyu HCIVSsembabule HCIVTiriri HCIVTokora HCIV
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
50
APPENDIX XII: SHOWING HEALTH FACILITIES THAT PLANNED, DID NOT ORDER BUT RECEIVED.Health Facility 2014/15 2015/16
RRH Fort Portal HospitalGulu HospitalMbarara University HospitalMubende Hospital
Gulu HospitalLira Hospital
GH Bududa HospitalKisoro HospitalMasindi HospitalTororo Hospital
Bududa HospitalBugiri HospitalKamuli HospitalKayunga HospitalKisoro HospitalNakaseke Hospital
HC IV Aduku HCIVAtiak HCIVBududa HospitalBukomero HCIVBukulula HCIVBusanza HCIVBusesa HCIVBushenyi HCIVBuvuma HCIVFort Portal HospitalGulu HospitalKarenga HCIVKisoro HospitalKumi HCIVKyabugimbi HCIVLalogi HCIVMasindi HospitalMbarara University HospitalMidigo HCIVMubende HospitalNagongera HCIVNamwendwa HCIVNdejje HCIVNtara HCIVOli HCIVRubuguri HCIVTororo Hospital
Aduku HCIVAmach HCIVBukulula HCIVBusesa HCIVButenga HCIVBuvuma HCIVBuwambo HCIVKabalye Pts Police HCIVKasangati HCIVKawempe HCIVKikuube HCIVKiruhura HCIVKumi HCIVLuweero HCIVNdejje HCIV
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
51
AP
PEN
DIX
XIII
: DIS
CR
EPA
NC
IES
RA
ISED
OVE
R T
HE
YEA
RS
WIT
H N
O R
ESP
ON
SE.
DA
TEC
UST
OM
ERFE
EDB
AC
K
NA
TUR
EO
RD
ER N
UM
BER
ITEM
INVE
STIG
ATI
ON
S
1/15
/201
3En
tebb
e H
ospi
tal
Dis
crep
ancy
1788
32P
GA/
Pol
ygla
tin G
0 P
GA/
Pol
glat
in G
11.
1 p
iece
mis
sing
2.Ite
m d
eliv
ered
but
doe
s no
t app
ear
on th
e de
liver
y no
te
3/15
/201
3R
ukun
yu H
C IV
Dis
crep
ancy
2008
93
3/15
/201
3K
inon
i HC
IVD
iscr
epan
cy
19
9240
, 199
731,
199
730,
198
471
4/24
/201
3N
tara
HC
IVD
iscr
epan
cy
2150
07P
ethi
dine
inj a
nd Q
uini
ne D
i-H
CL
5/29
/201
3N
akas
eke
Hos
pita
lN
on d
eliv
ery
TD
F/3T
C
6/28
/201
3En
tebb
e H
ospi
tal
Dis
crep
ancy
23
3343
Insu
lin S
olub
le a
nd In
sulin
Isop
hane
7/2/
2013
Mba
rara
R H
ospi
tal
Dis
crep
ancy
22
3017
Suxa
met
honi
um, C
otri
mox
mic
ro d
iscs
, Van
co
mic
ro d
iscs
and
Rita
mic
ro d
iscs
7/4/
2013
Mub
ende
R H
ospi
tal
Dis
crep
ancy
20
6241
Forc
ep d
enta
l, Tu
be e
ndot
rach
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asal
pla
stic
5.
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d Tu
be e
ndot
rach
eal n
asal
pla
stic
6m
m
7/15
/201
3B
udud
a H
ospi
tal
Dis
crep
ancy
23
4491
HIV
test
kits
.
7/25
/201
3K
yabu
gim
bi H
C IV
Qua
lity
issu
es
Exam
inat
ion
glov
es
7/29
/201
3Lu
wer
o H
C IV
Exce
ss s
uppl
y23
3215
ARVs
8/9/
2013
Buv
uma
HC
IVD
iscr
epan
cy
2368
06, 2
3680
7H
IV te
st k
its a
nd In
sulin
8/12
/201
3D
HO
Ale
bton
g O
ver
stoc
ked
item
s24
0396
BC
G, T
, OP
V an
d D
ropp
ers
8/13
/201
3Fo
rt P
orta
l R H
ospi
tal
Dis
crep
ancy
22
7758
Anti
TBs
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
52
8/22
/201
3B
ugob
ero
HC
IVD
iscr
epan
cy
2342
20
8/28
/201
3K
ikuu
be H
C IV
Ord
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ot fu
lly
serv
iced
P
ima
bead
s, N
evir
apin
e sy
rup
and
Lopi
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r/
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r
8/28
/201
3Li
ra R
HO
ver
stoc
ked
item
s24
6859
Uni
gold
9/6/
2013
Ente
bbe
Hos
pita
lD
iscr
epan
cy
2487
14Se
t inf
usio
n P
aedi
atri
c
9/9/
2013
Lalo
gi H
C IV
Dis
crep
ancy
24
5448
and
247
597
De-
Ioni
zed
wat
er a
nd G
love
s
9/10
/201
3Lu
wer
o H
C IV
Dis
crep
ancy
24
7963
Par
acet
amol
and
Neo
myc
in
9/10
/201
3Lu
wer
o H
C IV
Ord
er n
ot fu
lly
serv
iced
2479
63
9/16
/201
3D
HO
Kis
oro
Dis
crep
ancy
23
7946
Vita
min
A
9/25
/201
3D
HO
Kay
unga
Qua
lity
issu
es
Chl
orph
enam
ine
tabl
et a
nd P
heny
toin
sod
ium
10/2
2/20
13En
tebb
e H
ospi
tal
Dis
crep
ancy
2593
42C
hem
istr
y re
agen
ts
10/2
5/20
13B
ukom
ero
HC
IVD
iscr
epan
cy25
9243
Efav
iren
z 60
0mg
and
Tetr
acyc
line
eye
oint
men
t
10/2
5/20
13B
ukom
ero
HC
IVO
rder
not
fully
se
rvic
ed
Seve
ral I
tem
s
11/1
4/20
13Ig
anga
Hos
pita
lD
iscr
epan
cy
2647
24M
etro
nida
zole
sus
pens
ion
11/2
9/20
13K
umi H
C IV
Dis
crep
ancy
26
8678
HIV
test
kits
, D
oxyc
yclin
e an
d C
oart
em
12/9
/201
3G
ulu
R H
ospi
tal
Dis
crep
ancy
27
7629
, 277
691
Efav
iren
z, R
HE
12/1
0/20
13 B
ukom
ero
HC
IV
Non
del
iver
y
12/1
6/20
13Lu
wer
o H
CIV
Item
s no
t ord
ered
fo
r24
7963
, 261
412
Zido
vudi
ne, A
lben
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le
12/1
8/20
13En
tebb
e H
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tal
Not
ord
ered
for
2765
94Te
tanu
s An
titox
in In
ject
ion
12/2
0/20
13En
tebb
e H
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tal
Ove
r st
ocke
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m27
7832
Nev
irap
ine
200M
G
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
53
12/2
0/20
13En
tebb
e H
ospi
tal
Item
not
ord
ered
for
2778
04C
otri
mox
azol
e 96
0mg
tabs
12/2
0/20
13M
bara
ra R
Hos
pita
lIte
ms
not d
eliv
ered
2783
13
12/2
7/20
13M
bara
ra R
Hos
pita
lD
eliv
ered
less
by
100
2752
00H
epat
itis
B
12/3
0/20
13Lu
wer
o H
CIV
Item
s no
t rec
eive
d24
7963
Arte
suna
te in
j, ke
tam
ine,
clo
trim
azol
e
3/10
/201
4G
ulu
R H
ospi
tal
RF
Dis
crep
ancy
29
1562
HO
SAO
3/26
/201
4Lu
wer
o H
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DR
Ite
m n
ot o
rder
ed fo
r 29
3595
CC
A
3/26
/201
4Lu
wer
o H
C IV
D
RO
rder
not
fully
se
rvic
ed29
3048
CC
A
4/3/
2014
Kis
oro
Hos
pita
lR
FD
iscr
epan
cy
2912
81H
OSA
O
4/24
/201
4K
akut
o H
C IV
D
R/ L
ast m
ileD
iscr
epan
cy
2874
32H
OSA
O
5/6/
2014
Igan
ga H
ospi
tal
RF
Dis
crep
ancy
31
3449
HO
SAO
6/2/
2014
Kar
ugut
u H
C IV
R
FD
iscr
epan
cy
3184
87H
OSA
O
7/16
/201
4Lu
wer
o H
C IV
DR
/Las
t mile
Dis
crep
ancy
32
4583
HO
SAO
8/15
/201
4Lu
wer
o H
C IV
R
F/La
st M
ileD
iscr
epan
cy
0292
390,
292
386,
324
720
HO
SAO
8/21
/201
4M
bara
ra R
HR
F D
iscr
epan
cy
3281
90H
OSA
O
9/1/
2014
Fort
Por
tal R
Hos
pita
lLe
tter
/Las
t Mile
Dis
crep
ancy
3368
52H
OSA
O
9/1/
2014
Fort
Por
tal R
Hos
pita
lR
FEx
cess
sup
ply
3368
52, 3
3574
7, 3
3647
5H
OSA
O
9/15
/201
4M
bara
ra M
unic
ipal
HC
IV
CF
Dis
crep
ancy
33
4701
HO
SAO
6/10
/201
4Lu
wer
o H
C IV
D
R/L
ast M
ileD
iscr
epan
cy34
0785
HO
SAO
10/2
8/20
14K
inon
i HC
IV
CC
R M
bara
raD
iscr
epan
cy
3509
31H
OSA
O
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
54
11/1
0/20
14B
udud
a H
ospi
tal
CC
R M
bale
Dis
crep
ancy
35
8619
HO
SAO
11/1
3/20
14Lu
wer
o H
C IV
D
R/L
ast M
ileD
iscr
epan
cy
3576
18H
OSA
O
1/26
/201
5B
udud
a H
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tal
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Dis
crep
ancy
37
5979
HO
SAO
2/13
/201
5K
yabu
gim
bi H
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D
F D
iscr
epan
cy
3825
22H
OSA
O
2/26
/201
5B
ugan
gari
HC
IV
DF
Dis
crep
ancy
38
2958
HO
SAO
2/27
/201
5M
bara
ra M
unic
ipal
HC
IV
DF
Dis
crep
ancy
38
2798
HO
SAO
2/27
/201
5Fo
rt P
orta
l Hos
pita
lD
F D
iscr
epan
cy
3849
04H
OSA
O
6/8/
2015
Mub
ende
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pita
lD
F D
iscr
epan
cy
4199
34H
OSA
O
6/10
/201
5B
ugob
ero
HC
IV
RF
Item
s no
t ord
ered
fo
r40
8131
HO
SAO
6/17
/201
5G
ulu
Hos
pita
lD
F D
iscr
epan
cy
4208
03H
OSA
O
6/29
/201
5At
iak
HC
IV
DF
Dis
crep
ancy
42
0755
HO
SAO
6/29
/201
5O
li H
C IV
D
F D
iscr
epan
cy
4214
69H
OSA
O
6/30
/201
5N
agur
u M
PP
U P
olic
e C
linic
HC
IV
DF
Dis
crep
ancy
40
7313
HO
SAO
6/30
/201
5Lu
wer
o H
C IV
D
F D
iscr
epan
cy
4238
53H
OSA
O
MANAGEMENT OF PROCUREMENT AND DISTRIBUTION OF ESSENTIAL MEDICINES AND HEALTH SUPPLIESBY NATIONAL MEDICAL STORES | A REPORT BY THE AUDITOR GENERAL
55
T H E R E P U B L I C O F U G A N D A